Provider Demographics
NPI:1922557727
Name:LEGACY TREATMENT SERVICES
Entity Type:Organization
Organization Name:LEGACY TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CFO
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-267-5656
Mailing Address - Street 1:1289 ROUTE 38 WEST
Mailing Address - Street 2:SUITE #203
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2720
Mailing Address - Country:US
Mailing Address - Phone:609-288-3126
Mailing Address - Fax:609-265-1895
Practice Address - Street 1:5602 KIRKWOOD HIGHWAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:609-288-3126
Practice Address - Fax:609-265-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health