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General NPI Number Information
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NPI Number | 1003699752
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Entity Type | Organization
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Legal Business Name | LEGACY HEALING CENTER CALIFORNIA LLC
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 6519 CLEON AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-2707
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Country | US
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Telephone | 800-808-4570
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 EXCHANGE CT STE 185
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City | BOCA RATON
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State | FL
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Zip | 33431-4000
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Country | US
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Telephone | 561-308-0865
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | DAMARIS GONZALEZ
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Credential |
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Telephone | 561-308-0865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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