Provider Demographics
NPI:1255723300
Name:LEGACY TREATMENT CENTER ASHEVILLE
Entity type:Organization
Organization Name:LEGACY TREATMENT CENTER ASHEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-560-5238
Mailing Address - Street 1:4421 STUART ANDREW BLVD
Mailing Address - Street 2:SUITE 608
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1589
Mailing Address - Country:US
Mailing Address - Phone:954-560-5238
Mailing Address - Fax:888-510-9071
Practice Address - Street 1:900 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1734
Practice Address - Country:US
Practice Address - Phone:954-560-5238
Practice Address - Fax:888-510-9071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility