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General NPI Number Information
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NPI Number | 1740079243
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Entity Type | Organization
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Legal Business Name | LEGENDS RECOVERY CENTER OF OHIO LLC
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 430 N BROADWAY ST
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City | GREEN SPRINGS
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State | OH
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Zip | 44836-9734
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Country | US
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Telephone | 419-307-9128
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Fax |
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Provider Business Mailing Address
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Address Line | 95 MAIN AVE STE 121
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City | CLIFTON
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State | NJ
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Zip | 07014-1757
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JOSHUA KOENIG
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Credential |
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Telephone | 908-627-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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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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