Legacy Wellness LLC
Clinic/Center, Rehabilitation, Substance Use Disorder in Edmond, OK. Organization (NPI-2).
NPI number1104735596
StatusActive
Last updated in NPPESSep 2, 2026
Details
- NPI
- 1104735596
- Entity type
- Organization (NPI-2)
- Legal business name
- Legacy Wellness LLC
- Organization subpart
- No
- Enumeration date
- Sep 2, 2026
- Certification date
- Sep 2, 2026
- Last updated
- Sep 2, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – | Yes |
Practice location
609 S Kelly Ave Bldg FEdmond, OK 73003-5659
Phone 949-522-1469
Mailing address
609 S Kelly Ave Bldg FEdmond, OK 73003-5659
Phone 949-522-1469
Authorized official
Dolton Beckstead
Cfo
9495221469
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