Healthcare Provider Details

I. General information

NPI: 1336707793
Provider Name (Legal Business Name): LEGACY TREATMENT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ROUTE US 9 S STE 202
MARMORA NJ
08223-1271
US

IV. Provider business mailing address

1289 ROUTE 38 STE 203
HAINESPORT NJ
08036-2730
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-5656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA BAILEY
Title or Position: BUSINESS ANALYST
Credential:
Phone: 609-288-3169