Provider Demographics
NPI:1942939764
Name:LEGENDS RECOVERY CENTER OF OHIO LLC
Entity Type:Organization
Organization Name:LEGENDS RECOVERY CENTER OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE/PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:I
Authorized Official - Last Name:DUDEK
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MHA,CAP
Authorized Official - Phone:561-301-9423
Mailing Address - Street 1:95 MAIN AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1757
Mailing Address - Country:US
Mailing Address - Phone:844-534-3638
Mailing Address - Fax:
Practice Address - Street 1:430 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GREEN SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:44836-9734
Practice Address - Country:US
Practice Address - Phone:844-534-3638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility