Provider Demographics
NPI:1356146385
Name:LEGACY RECOVERY CENTER LLC
Entity type:Organization
Organization Name:LEGACY RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-615-0981
Mailing Address - Street 1:24745 S LINDSAY RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-9581
Mailing Address - Country:US
Mailing Address - Phone:936-615-0981
Mailing Address - Fax:
Practice Address - Street 1:2338 E MINTON ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-1428
Practice Address - Country:US
Practice Address - Phone:936-615-0981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY RECOVERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility