Healthcare Provider Details

I. General information

NPI: 1730594656
Provider Name (Legal Business Name): LEGACY TREATMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 ROUTE 38 SUITE #203
HAINESPORT NJ
08036-2730
US

IV. Provider business mailing address

1289 ROUTE 38 SUITE #203
HAINESPORT NJ
08036-2730
US

V. Phone/Fax

Practice location:
  • Phone: 609-288-3067
  • Fax: 609-265-1895
Mailing address:
  • Phone: 609-288-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNJ

VIII. Authorized Official

Name: CHRISTINE KIRKBRIDE
Title or Position: CEO
Credential:
Phone: 609-267-5656