NPI 1225721707

Legacy Village Outpatient Id, LLC

Organisation Substance Abuse Rehabilitation Facility Boise, ID

Practice location

Address: 800 W Main St STE 1460, Boise, ID 83702-5983
Phone: (800) 997-6977
Fax: (661) 489-0573

Authorised official

Name: Dennis Scott Farmer
Title: Chief Executive Officer
Phone: (800) 997-6977

Registered specialties (2)

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X

Other Substance Abuse Rehabilitation Facility providers in Idaho →

Mental Health Clinic/Center (Including Community Mental Health Center)

Ambulatory Health Care Facilities Taxonomy 261QM0801X

Other Clinic/Center providers in Idaho →

Registry record

NPI: 1225721707
Entity type: Organization
NPI issued: 31 May 2023
Record last updated: 31 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.