Provider Demographics
NPI:1811447832
Name:LEGACY HEALING CENTER MARGATE, LLC
Entity type:Organization
Organization Name:LEGACY HEALING CENTER MARGATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-271-0945
Mailing Address - Street 1:2960 N STATE ROAD 7
Mailing Address - Street 2:#102
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2960 N STATE ROAD 7
Practice Address - Street 2:#102
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5755
Practice Address - Country:US
Practice Address - Phone:888-534-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder