Provider Demographics
NPI:1477062487
Name:NEW LEGACY RECOVERY LLC
Entity Type:Organization
Organization Name:NEW LEGACY RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-419-5700
Mailing Address - Street 1:PO BOX 12295
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40582-2295
Mailing Address - Country:US
Mailing Address - Phone:859-618-6800
Mailing Address - Fax:949-315-3013
Practice Address - Street 1:1510 NEWTOWN PIKE STE 120
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1255
Practice Address - Country:US
Practice Address - Phone:859-618-6800
Practice Address - Fax:949-315-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY810588261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder