Provider Demographics
NPI:1003507500
Name:LEGACY HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:LEGACY HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-395-5011
Mailing Address - Street 1:2921 N TENAYA WAY STE 128
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1411
Mailing Address - Country:US
Mailing Address - Phone:702-978-8000
Mailing Address - Fax:
Practice Address - Street 1:2921 N TENAYA WAY STE 128
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1411
Practice Address - Country:US
Practice Address - Phone:702-978-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY HEALTH AND WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-16
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility