Provider Demographics
NPI:1275212573
Name:LEGACY COMMUNITY SOLUTIONS INCORPORATED
Entity Type:Organization
Organization Name:LEGACY COMMUNITY SOLUTIONS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-274-1053
Mailing Address - Street 1:4100 S HOSPITAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2831
Mailing Address - Country:US
Mailing Address - Phone:954-769-1055
Mailing Address - Fax:954-533-1739
Practice Address - Street 1:4100 S HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2831
Practice Address - Country:US
Practice Address - Phone:954-769-1055
Practice Address - Fax:954-533-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Multi-Specialty