LEGACY TREATMENT LLC (NPI# 1417422965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417422965 |
| Entity Type | Organization |
| Organization Name | LEGACY TREATMENT LLC |
| Practice Address |
1438 Liberty Rd Sykesville MD 21784 |
| Mailing Address |
1438 Liberty Rd Sykesville MD 21784-6493 |
| Practice Telephone | 4436094302 |
| Practice Fax Number | 4436094625 |
| Mailing Telephone | 4436094602 |
| Mailing Fax Number | 4436094625 |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2018-10-11 |
| Authorized Official Name | LLOYD A WYNN (COO) |
| Authorized Official Telephone | 9735588514 |
| Is Organization Subpart | Y |
| Parent Organization Name | LEGACY TREATMENT LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952877219 | Legacy Treatment LLC | Counselor | 4432 Park Heights Ave, Baltimore, MD 21215-6315 | 2018-10-15 |
| 1841765393 | Legacy Treatment LLC | Counselor | 8610 Washington Blvd, Jessup, MD 20794-9499 | 2018-10-11 |
| 1912472473 | Legacy Treatment LLC | Counselor | 4432 Park Heights Ave, Baltimore, MD 21215-6315 | 2018-10-10 |
| Street Address |
1438 LIBERTY RD |
| City | SYKESVILLE |
| State | MD |
| Zip Code | 21784 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922417377 | Junior Kermens Amilcar | Pharmacist | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2014-08-11 |
| 1003260639 | Judy Barragan | Social Worker | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2016-04-20 |
| 1366801466 | I Can't We Can Counseling Center | Clinic/Center | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2016-02-17 |
| 1902265093 | I Can't We Can Counseling Center | Community Based Residential Treatment Facility, Mental Illness | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2016-02-17 |
| 1497113146 | I Can't We Can Counseling Center | Community Based Residential Treatment Facility, Mental Illness | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2016-02-09 |
| 1730545419 | Ican't We Can | Substance Abuse Rehabilitation Facility | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2016-01-11 |
| 1497154363 | Michael Mutolo | Pharmacist | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2014-08-17 |
| 1881003093 | Marut Gadani | Pharmacist | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2014-08-13 |
| 1932518115 | Ankit Ghodasara | Pharmacist | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2014-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033681085 | Kathleen Busching | Occupational Therapy Assistant | Intergrace Fairhaven, 7200 Third Ave, Sykesville, MD 21784 | 2018-12-31 |
| 1619450376 | Mackenzie Fleming | Counselor | 6220 Georgetown Blvd Suite C, Eldersburg, MD 21784 | 2018-09-10 |
| 1316426919 | Rebecca Rubin | Nurse Practitioner | 1380 Progress Way, Suite 102, Eldersburg, MD 21784 | 2018-08-14 |
| 1417473273 | Andrey Doroshenko | Dentist | 1722 Underwood Road, Sykesville, MD 21784 | 2017-08-14 |
| 1992229694 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 6400 Georgetown Blvd, Eldersburg, MD 21784 | 2017-08-03 |
| 1457894495 | Bethany Six | Nurse Practitioner | 6190 Gerogetown Blvd, Eldersburg, MD 21784 | 2016-11-23 |
| 1982011821 | Fast Track Urgent Care, LLC | Clinic/Center | 1315 Breton Drive, Eldersburg, MD 21784 | 2014-07-11 |
| 1588097984 | Centers for Advanced Orthopaedics, LLC | Orthopaedic Surgery | 5961 Exchange Dr, Suite 100, Eldersburg, MD 21784 | 2013-08-21 |
| 1356690986 | Kayla Nicole Koster | Speech-Language Pathologist | 1702 Liberty Road, First Floor, Sykesville, MD 21784 | 2012-08-29 |
| 1558645663 | Fusion Dental | Dentist | 5959 Exchange Drive, Suite 116, Eldersburg, MD 21784 | 2011-10-07 |
| Find all providers in zip 21784 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366801466 | I Can't We Can Counseling Center | Clinic/Center | 1438 Liberty Rd, Sykesville, MD 21784-6493 | 2016-02-17 |
| 1265730964 | Maryland Treatment Centers, Inc. | Clinic/Center | 6655 Sykesville Rd, Sykesville, MD 21784-7966 | 2011-03-03 |
| 1487891917 | Maryland Treatment Centers, Inc | Clinic/Center | 6655 Sykesville Rd, Sykesville, MD 21784-7966 | 2009-01-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043817075 | Maryland Community Health Initiatives, Inc. | Clinic/Center | 2648 Guilford Ave Apt 1fl, Baltimore, MD 21218-4611 | 2020-10-02 |
| 1851998892 | Maryland Community Health Initiatives, Inc. | Clinic/Center | 2648 Guilford Ave Apt 2fl, Baltimore, MD 21218-4611 | 2020-10-02 |
| 1801403324 | Maryland Community Health Initiatives, Inc. | Clinic/Center | 328 E 26th St, Baltimore, MD 21218-4702 | 2020-09-29 |
| 1275148975 | Hel Recovery Center | Clinic/Center | 1900 N Howard St Fl 2, Baltimore, MD 21218-5909 | 2020-09-10 |
| 1497365654 | Inspiring Change Mental Health Services, LLC. | Clinic/Center | 4654 York Rd Ste 1, Baltimore, MD 21212-4726 | 2020-08-03 |
| 1174132518 | Sabinas House LLC | Clinic/Center | 3103 Mareco Ave, Baltimore, MD 21213-1619 | 2020-07-30 |
| 1134738909 | Sabinas House LLC | Clinic/Center | 2224 Dukeland St, Baltimore, MD 21216-2812 | 2020-07-28 |
| 1881203792 | Sabinas House LLC | Clinic/Center | 3325 Shannon Dr, Baltimore, MD 21213-1823 | 2020-07-27 |
| 1356950265 | Sabinas House LLC | Clinic/Center | 616 Wildwood Pkwy, Baltimore, MD 21229-1810 | 2020-07-27 |
| 1598374407 | Sabinas House LLC | Clinic/Center | 605 Springfield Ave, Baltimore, MD 21212-4832 | 2020-07-27 |
| Find all providers with the same taxonomy | ||||
| City | SYKESVILLE |
| Zip Code | 21784 |
Please comment or provide details below to improve the information on LEGACY TREATMENT LLC.
| 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.