Provider Demographics
NPI:1508371154
Name:LEGACY III, INC.
Entity Type:Organization
Organization Name:LEGACY III, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-375-0071
Mailing Address - Street 1:733 W MARKET ST STE B5A
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1009
Mailing Address - Country:US
Mailing Address - Phone:330-375-0071
Mailing Address - Fax:330-375-0072
Practice Address - Street 1:733 W MARKET ST STE B5A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1009
Practice Address - Country:US
Practice Address - Phone:330-375-0071
Practice Address - Fax:330-375-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health