Provider Demographics
NPI:1588402770
Name:VILLAGE OF LEGACY
Entity type:Organization
Organization Name:VILLAGE OF LEGACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TORIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-699-3640
Mailing Address - Street 1:2665 W VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4790
Mailing Address - Country:US
Mailing Address - Phone:419-699-3640
Mailing Address - Fax:
Practice Address - Street 1:5151 MONROE ST STE 101
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3456
Practice Address - Country:US
Practice Address - Phone:419-699-3640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health