MEDICARE: LEGACY TREATMENT SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1649802646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY TREATMENT SERVICES, INC.

Provider Business Mailing Address
First Line	:	1289 ROUTE 38 STE 203
Second Line	:
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2730
Country	:	US
Telephone Number	:	609-267-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	1187 E WASHINGTON LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1061
Country	:	US
Telephone Number	:	609-267-5656
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	SHABNAM SHARMA
Credential	:
Telephone Number	:	856-642-9090

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	02/07/2020

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