LEGACY TREATMENT CENTER (NPI# 1700289642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700289642 |
| Entity Type | Organization |
| Organization Name | LEGACY TREATMENT CENTER |
| Practice Address |
3824 Barrett Dr Suite 310 Raleigh NC 27609-7220 |
| Mailing Address |
4421 Stuart Andrew Blvd Suite 106 Charlotte NC 28217-1589 |
| Practice Telephone | 9545605238 |
| Practice Fax Number | 8885109071 |
| Mailing Telephone | 9545605238 |
| Mailing Fax Number | 8885109071 |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2014-10-07 |
| Authorized Official Name | BRAD WILKERSON (CEO) |
| Authorized Official Telephone | 9545605238 |
| Is Organization Subpart | Y |
| Parent Organization Name | LEGACY TREATMENT CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | MHL-060-1265 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | CLIA | 34D2054739 | 01 |
| NC | NC STATE LICENSE | MHL-060-1265 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730567033 | Legacy Treatment Center | Substance Abuse Rehabilitation Facility | 5401 New Centre Drive, Suite 200, Wilmington, NC 28403 | 2015-05-07 |
| 1053758102 | Legacy Treatment Center | Substance Abuse Rehabilitation Facility | 4421 Stuart Andrew Blvd, Suite 608, Charlotte, NC 28217-1589 | 2013-05-30 |
| 1578904603 | Legacy Treatment Center | Clinical Medical Laboratory | 4421 Stuart Andrew Blvd, Suite 608, Charlotte, NC 28217-1589 | 2013-07-17 |
| Street Address |
3824 BARRETT DR SUITE 310 |
| City | RALEIGH |
| State | NC |
| Zip Code | 27609-7220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659497154 | Your Choice Services Inc | Day Training, Developmentally Disabled Services | 3824 Barrett Dr, Suite 105, Raleigh, NC 27609-7220 | 2007-03-22 |
| 1619349867 | Amy Bowles Propst | Social Worker | 3824 Barrett Dr, Suite 306, Raleigh, NC 27609-7220 | 2015-10-28 |
| 1881079325 | Your Choice Services, Inc. | Day Training, Developmentally Disabled Services | 3824 Barrett Dr, Suite 105, Raleigh, NC 27609-7220 | 2015-07-27 |
| 1902208176 | Matthew Wright | Social Worker | 3824 Barrett Dr, Ste. 200, Raleigh, NC 27609-7220 | 2014-09-19 |
| 1912306564 | Your Choice Services, Inc | Day Training, Developmentally Disabled Services | 3824 Barrett Dr, Ste 105, Raleigh, NC 27609-7220 | 2014-08-20 |
| 1003215658 | Your Choice Services, Inc. | Day Training, Developmentally Disabled Services | 3824 Barrett Dr, Ste 105, Raleigh, NC 27609-7220 | 2014-08-20 |
| 1285033829 | Your Choice Services, Inc. | Day Training, Developmentally Disabled Services | 3824 Barrett Dr, 105, Raleigh, NC 27609-7220 | 2014-08-20 |
| 1194124743 | Your Choice Services, Inc | Day Training, Developmentally Disabled Services | 3824 Barrett Dr, Suite 105, Raleigh, NC 27609-7220 | 2014-08-20 |
| 1881008761 | Your Choice Services, Inc | Day Training, Developmentally Disabled Services | 3824 Barrett Dr, Suite 105, Raleigh, NC 27609-7220 | 2014-06-18 |
| 1740693811 | Brian Grover | Psychologist | 3824 Barrett Dr, #101, Raleigh, NC 27609-7220 | 2014-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184235582 | Choice Service Solutions LLC | In Home Supportive Care | 5300 Six Fox Rd Siite205, Raleigh, NC 27609 | 2020-08-11 |
| 1003426073 | Rosana Oba -rovira | Registered Nurse | 5300 Six Fox Road, Suite 205, Raleigh, NC 27609 | 2020-08-05 |
| 1821612706 | Helen Alexandra Bonner | Physical Medicine & Rehabilitation | Hey Clinic Pa, 3320 Wake Forest Road Ste 450, Raleigh, NC 27609 | 2020-06-05 |
| 1215423579 | Appiah Nana Larbi | Social Worker | Easter Seals Ucp 4000 Wake Forest Rd Ste 200, Raleigh, NC 27609 | 2018-07-10 |
| 1215423777 | Broadway Home Care LLC | In Home Supportive Care | 107 Windel Dr Ste 105, Raleigh, NC 27609 | 2018-07-09 |
| 1275027948 | Lacey Allene Cottingham | Social Worker | 312 W Millbrook Rd Ste 129, Raleigh, NC 27609 | 2018-06-18 |
| 1447748819 | Integrated Dermatology of North Raleigh, Pllc | Dermatology | 3809 Computer Dr Ste 200, Raleigh, NC 27609 | 2018-05-01 |
| 1902325418 | Naomi Christine Askew | Nurse Practitioner | 3400 Wake Forest Drive, Bldg 9, Bldg #9, 4th Floor, Raleigh, NC 27609 | 2017-09-15 |
| 1962929679 | Alexia Montague | Social Worker | 1306 Paddock Drive Suite E-100, Raleigh, NC 27609 | 2017-08-23 |
| 1730602236 | Chantel Washington-mbuthia | Counselor | 1100 Logger Ct. Ste C100, Heartfelt Alternative Inc, Raleigh, NC 27609 | 2017-07-18 |
| Find all providers in zip 27609 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831715002 | Summit Prairie Recovery Center | Substance Abuse Rehabilitation Facility | 7785 Saint Gertrude Ave, Raleigh, ND 58564-4103 | 2020-06-23 |
| 1477995710 | Unc Addiction Treatment Center | Substance Abuse Rehabilitation Facility | 107 Sunnybrook Rd, Raleigh, NC 27610-1827 | 2013-07-29 |
| 1861834277 | Unc Health Care | Substance Abuse Rehabilitation Facility | 107 Sunnybrook Rd, Raleigh, NC 27610-1827 | 2013-07-26 |
| 1124146980 | Prairie Learning Center | Substance Abuse Rehabilitation Facility | 7785 Saint Gertrude Ave, Raleigh, ND 58564-4103 | 2007-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790395457 | Changing Paths of Nc 2 LLC | Substance Abuse Rehabilitation Facility | 150 Cedar Ln, Rose Hill, NC 28458 | 2020-08-06 |
| 1982212874 | Hall Empowerment Network | Substance Abuse Rehabilitation Facility | 4450 Kinkead Ct Apt 33, Fayetteville, NC 28314-2420 | 2020-07-16 |
| 1710504642 | The Awakening Wellness Clinic, Inc | Substance Abuse Rehabilitation Facility | 8 Carver Rd, Jacksonville, NC 28540-7010 | 2020-06-26 |
| 1609408269 | Pear Tree Peace Community Economic Development Corporation | Substance Abuse Rehabilitation Facility | 612 Pine Tops Rd, Murfreesboro, NC 27855-9595 | 2020-02-11 |
| 1396383352 | Deerhaven Gardens, LLC. | Substance Abuse Rehabilitation Facility | 66 N Deerhaven Ln, Asheville, NC 28803-0120 | 2019-12-20 |
| 1255973210 | Blissfully Supported LLC | Substance Abuse Rehabilitation Facility | 645 Dunbrook Ln, Charlotte, NC 28217-3405 | 2019-10-11 |
| 1235785726 | Eighth Month Ventures, LLC | Substance Abuse Rehabilitation Facility | 405 Franklin Blvd, Greensboro, NC 27401-4610 | 2019-08-12 |
| 1538720396 | Adaptive Interventions Group, LLC | Substance Abuse Rehabilitation Facility | 107 Robinson Dr, Cherryville, NC 28021-8100 | 2019-06-24 |
| 1356813802 | Red Oak Adolescent Recovery LLC | Substance Abuse Rehabilitation Facility | 517 Cub Creek Rd, Ellenboro, NC 28040-8733 | 2018-12-21 |
| 1619475308 | Titan Holding Group, LLC | Substance Abuse Rehabilitation Facility | 4944 Parkway Plaza Ste 200, Charlotte, NC 28217-0000 | 2018-01-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.