OrganizationActive
Legacy Treatment Center LLC
NPI 1336940717 · Addiction Medicine (Family Medicine) Physician · Fort Wayne, IN
Provider details
- NPI number
- 1336940717
- Entity type
- Organization
- Primary specialty
- Addiction Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Abdul Barrie, Ceo(260) 201-3119
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
3030 Lake Ave Ste 24
Fort Wayne, IN 46805-5428
Phone: (260) 705-4587
Approximate (ZIP-level) locationGet directions
Mailing address
3030 Lake Ave Ste 24
Fort Wayne, IN 46805-5428
Registry dates
- Enumerated
- 2025-03-21
- Last updated
- 2025-12-12
- Certified
- 2025-12-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.