LEGACY TREATMENT CENTER (NPI# 1053758102) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053758102 |
| Entity Type | Organization |
| Organization Name | LEGACY TREATMENT CENTER |
| Practice Address |
4421 Stuart Andrew Blvd Suite 608 Charlotte NC 28217-1589 |
| Practice Telephone | 5617159288 |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2013-07-11 |
| Authorized Official Name | ANGELA IACULLO (BILLING DIRECTOR) |
| Authorized Official Telephone | 5617159288 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES | 130037 | 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 |
| 1700289642 | Legacy Treatment Center | Substance Abuse Rehabilitation Facility | 3824 Barrett Dr, Suite 310, Raleigh, NC 27609-7220 | 2014-10-07 |
| 1578904603 | Legacy Treatment Center | Clinical Medical Laboratory | 4421 Stuart Andrew Blvd, Suite 608, Charlotte, NC 28217-1589 | 2013-07-17 |
| Street Address |
4421 STUART ANDREW BLVD SUITE 608 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28217-1589 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578904603 | Legacy Treatment Center | Clinical Medical Laboratory | 4421 Stuart Andrew Blvd, Suite 608, Charlotte, NC 28217-1589 | 2013-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962017798 | Kelby Rae Hurlocker | Specialist/Technologist | 500 Center Park Dr, Charlotte, NC 28217 | 2020-09-09 |
| 1356967749 | Optum Pharmacy 701, LLC | Pharmacy | 4015 Shopton Rd, Suite 600, Charlotte, NC 28217 | 2020-06-22 |
| 1598302937 | Brigit Boyce | Occupational Therapist | 8848 Red Oak Blvd, Ste Aa, Charlotte, NC 28217 | 2019-12-04 |
| 1275016933 | Zarah Pulfrey | Physician Assistant | Womack Medical Center, 2817 Riley Road, Fort Bragg, NC 28217 | 2018-09-10 |
| 1972085918 | Dynamic Health Medical Group Pllc | Pain Medicine | 4705 South Blvd, Charlotte, NC 28217 | 2018-09-06 |
| 1184102048 | Charday Caple | Counselor | 735 Echodale Dr, Charlotte, NC 28217 | 2018-08-02 |
| 1326532250 | Dupont Livery LLC | Non-emergency Medical Transport (VAN) | 4200 S Tryon St, Charlotte, NC 28217 | 2018-06-14 |
| 1891215232 | Lakesha Shamise Welch | Counselor | 5709 South Hampton R., Charlotte, NC 28217 | 2017-06-27 |
| 1245768282 | Allison Harris Lafone | Counselor | 515 Clanton Road, Charlotte, NC 28217 | 2017-06-02 |
| 1619416906 | Charlie Randolph Taylor Jr. | Counselor | 517 Clanton Road, Charlotte, NC 28217 | 2017-02-20 |
| Find all providers in zip 28217 | ||||
| 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 |
|---|---|---|---|---|
| 1255973210 | Blissfully Supported LLC | Substance Abuse Rehabilitation Facility | 645 Dunbrook Ln, Charlotte, NC 28217-3405 | 2019-10-11 |
| 1619475308 | Titan Holding Group, LLC | Substance Abuse Rehabilitation Facility | 4944 Parkway Plaza Ste 200, Charlotte, NC 28217-0000 | 2018-01-27 |
| 1063860666 | Legacy Freedom Treatment Center | Substance Abuse Rehabilitation Facility | 4944 Parkway Plaza Blvd, Suite 300, Charlotte, NC 28217-1972 | 2016-05-25 |
| 1255793873 | Anuvia Prevention and Recovery Center | Substance Abuse Rehabilitation Facility | 8503 Parkland Cir, Apt 304, Charlotte, NC 28227-2208 | 2016-03-23 |
| 1659765782 | Veteran Enterprise Group, LLC | Substance Abuse Rehabilitation Facility | 4600 Eastwycke Place Dr, Charlotte, NC 28215-4278 | 2015-03-26 |
| 1073790192 | New Creations Rehabilitation Center | Substance Abuse Rehabilitation Facility | 2236 Gooseberry Rd, Charlotte, NC 28208-2598 | 2008-01-31 |
| 1154706307 | Anuvia Prevention and Recovery Center, Inc | Substance Abuse Rehabilitation Facility | 429 Billingsley Rd, Charlotte, NC 28211-1007 | 2015-07-29 |
| 1013390590 | Carter Treatment Center | Substance Abuse Rehabilitation Facility | 1904 Oroville Ct, Charlotte, NC 28214-2567 | 2015-07-02 |
| 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 |
| 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 |
| 1144737016 | Sea Coast Recovery, LLC | Substance Abuse Rehabilitation Facility | 880 Martin Luther King Jr Blvd, Chapel Hill, NC 27514-2600 | 2018-01-02 |
| 1689198772 | Recovery On The Ridge LLC | Substance Abuse Rehabilitation Facility | 2145 Cane Creek Rd., Fletcher, NC 28732 | 2017-07-31 |
| 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.