Provider Demographics
NPI:1003699752
Name:LEGACY HEALING CENTER CALIFORNIA LLC
Entity type:Organization
Organization Name:LEGACY HEALING CENTER CALIFORNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-308-0865
Mailing Address - Street 1:4700 EXCHANGE CT STE 185
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4000
Mailing Address - Country:US
Mailing Address - Phone:561-308-0865
Mailing Address - Fax:
Practice Address - Street 1:6519 CLEON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2707
Practice Address - Country:US
Practice Address - Phone:800-808-4570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility