NPI 1003506171
Legacy Residential Program
Practice location
- Address
- 2156 N 30th St, Philadelphia, PA 19121-1101
- Phone
- (267) 315-5124
- Fax
- (267) 324-3106
- Mailing address
- 8480 Limekiln Pike Ph 5, Wyncote, PA 19095-2816
Authorised official
- Name
- Ashley Edwards
- Title
- Ceo
- Phone
- (215) 397-7823
Registered specialties (8)
Case Management Agency
Primary
Assisted Living Facility (Mental Illness)
Intellectual Disabilities Intermediate Care Facility
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Mental Illness Community Based Residential Treatment Facility
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Psychiatric Residential Treatment Facility
Substance Abuse Rehabilitation Facility
Registry record
- NPI
- 1003506171
- Entity type
- Organization
- NPI issued
- 11 May 2023
- Record last updated
- 11 May 2023
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.