Legacy Residential Program

LBN: Legacy Residential Program
Legacy Residential Program is an health care organization with primary practice located at 2156 N 30Th St , Philadelphia PA 19121-1101. The organization recently has 8 registered licenses in different health care specialties including Agencies / Case Management, Nursing & Custodial Care Facilities / Assisted Living, Mental Illness, Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness, Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, Residential Treatment Facilities / Psychiatric Residential Treatment Facility, Residential Treatment Facilities / Substance Abuse Rehabilitation Facility. Agencies / Case Management is the primary health care specialty. Legacy Residential Program can be contacted via phone (267) 315-5124, or through Edwards, Ashley via phone (215) 397-7823.

Contact Information

Primary practice address
2156 N 30Th St Philadelphia PA 19121-1101
Phone: (267) 315-5124
Fax: (267) 324-3106
Website:
Map and Directions
Authorized official contact:
Name: Edwards, Ashley Registered Nurse (RN)
Phone: (215) 397-7823

Health care specialties

SpecialtyCodeLicense #State
Agencies / Case Management 251B00000X
Nursing & Custodial Care Facilities / Assisted Living, Mental Illness 3104A0625X
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Illness 320800000X
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X
Residential Treatment Facilities / Psychiatric Residential Treatment Facility 323P00000X
Residential Treatment Facilities / Substance Abuse Rehabilitation Facility 324500000X

Profile Details

NPI number 1003506171
LBN Legal business name Legacy Residential Program
DBA Doing business as
Authorized official Edwards, Ashley Registered Nurse (RN)
Entity Organization
Organization subpart 1 No
Enumeration date May 11th, 2023
Last updated May 11th, 2023 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003506171 NPPES
Delaware MEDICAID 1366151854
Delaware MEDICAID 1386342533

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