Legacy Village Hq, LLC

NPI #1275225310 in Boise, Idaho

Provider Information

NPI Number
1275225310
Entity Type
Organization
Organization Name
Legacy Village Hq, LLC
Primary Specialty
Substance Abuse Rehabilitation Facility
Enumeration Date
May 25, 2023
Last Updated
May 25, 2023

Practice Location

Address
800 W MAIN ST STE 1460
City
Boise
State
Idaho
ZIP Code
83702-5983
Phone
(800) 997-6977

Authorized Official

Name
MR. DENNIS SCOTT FARMER
Title
CHIEF EXECUTIVE OFFICER
Phone
(800) 997-6977

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Mental Health (Including Community Mental Health Center)Mental Health (Including Community Mental Health Center)
Substance Abuse Rehabilitation Facility

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