Healthcare Provider Details

I. General information

NPI: 1114870946
Provider Name (Legal Business Name): THE REID LEGACY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 FALLS CREEK DR
SPRING LAKE NC
28390-4606
US

IV. Provider business mailing address

1157 COACHMAN WAY
SANFORD NC
27332-6190
US

V. Phone/Fax

Practice location:
  • Phone: 828-228-5299
  • Fax:
Mailing address:
  • Phone: 828-228-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RODNEY LAMONT REID
Title or Position: OWNER
Credential:
Phone: 828-228-5299