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General NPI Number Information
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NPI Number | 1386982932
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 911 N BUFFALO DR UNIT 213
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City | LAS VEGAS
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State | NV
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Zip | 89128-0381
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Country | US
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Telephone | 702-366-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 911 N BUFFALO DR UNIT 213
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City | LAS VEGAS
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State | NV
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Zip | 89128-0381
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Country | US
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Telephone | 702-366-3340
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ABBY MARIE GROSSA
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Credential |
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Telephone | 702-338-8373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | E0435602012-5
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License Number State | NV
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