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NPI Code Detail

MEDICARE: LEGENDS RECOVERY CENTER OF OHIO LLC

MEDICARE: LEGENDS RECOVERY CENTER OF OHIO LLC
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
1324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1942939764
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGENDS RECOVERY CENTER OF OHIO LLC
Provider Business Mailing Address
First Line : 95 MAIN AVE STE 121
Second Line :
City : CLIFTON
State : NJ
Zip : 07014-1757
Country : US
Telephone Number : 844-534-3638
Fax Number :
Provider Business Practice Location Address
First Line : 430 N BROADWAY ST
Second Line :
City : GREEN SPRINGS
State : OH
Zip : 44836-9734
Country : US
Telephone Number : 844-534-3638
Fax Number :
Authorized Official
Title or Position : CHIEF COMPLIANCE/PROJECT MANAGER
Name : EVA I DUDEK
Credential : BS,MHA,CAP
Telephone Number : 561-301-9423
Provider Enumeration Date : 06/07/2022
Last Update Date : 06/07/2022

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Directions to “LEGENDS RECOVERY CENTER OF OHIO LLC ” Practice Location

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