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General NPI Number Information
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NPI Number | 1508371154
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Entity Type | Organization
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Legal Business Name | LEGACY III, INC.
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 733 W MARKET ST STE B5A
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City | AKRON
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State | OH
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Zip | 44303-1009
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Country | US
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Telephone | 330-375-0071
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Fax | 330-375-0072
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Provider Business Mailing Address
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Address Line | 733 W MARKET ST STE B5A
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City | AKRON
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State | OH
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Zip | 44303-1009
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Country | US
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Telephone | 330-375-0071
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Fax | 330-375-0072
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | MR. GARY A. MORGAN
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Credential |
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Telephone | 330-375-0071
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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 |
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License Number State |
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