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Legacy Village, Llc
Substance Abuse Rehabilitation Facility in Nipomo, California
NPI 1295185841

Legacy Village, Llc is a Substance Abuse Rehabilitation Facility based in Nipomo, CA. Legacy Village, Llc practices in Nipomo, CA. The NPI Number for Legacy Village, Llc is 1295185841 and holds a License No. (California).

The current practice location address for Legacy Village, Llc is 230 Hans Pl, Nipomo, CA and can be reached out via phone at 805-792-3595 and via fax at 661-489-0573.

Location: 230 Hans Pl, Nipomo, CA, 93444-5025
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1295185841
Provider Name
Legacy Village, Llc
Credential
Provider Entity Type
Organization
Address
230 Hans Pl, Nipomo, CA, 93444-5025
Phone Number
805-792-3595
Fax Number
661-489-0573
Provider Enumeration Date
06/14/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
150071AP 01 CA RESIDENTIAL TREATMENT LICENSE
institution
Provider Business Practice Location Address Details
Address
230 Hans Pl
City
Nipomo
State
California
Zip
93444-5025
Phone Number
805-792-3595
Fax Number
661-489-0573
person
Provider Business Mailing Address Details
Address
230 Hans Pl
City
Nipomo
State
California
Zip
93444-5025
Phone Number
805-792-3595
Fax Number
661-489-0573
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Mental Illness
Speciality
-
Taxonomy
320800000X
License No.
(California)
Definition
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Substance Abuse Rehabilitation Facility
Speciality
-
Taxonomy
324500000X
License No.
()
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
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