Healthcare Provider Details

I. General information

NPI: 1144728221
Provider Name (Legal Business Name): LEGACY TREATMENT SERIVCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PINE ST
MOUNT HOLLY NJ
08060-2207
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 Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RONALD DAVIS
Title or Position: BILLING MANAGER
Credential:
Phone: 609-267-5656