Legacy Treatment Center LLC
NPI 1336940717 · Addiction Medicine (Family Medicine) Physician · Fort Wayne, IN
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Legacy Treatment Center LLC is a Addiction Medicine (Family Medicine) Physician organization in Fort Wayne, IN (NPI 1336940717).
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
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
1 yr in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2025-03-21
- Last updated
- 2025-12-12
- Certified
- 2025-12-12
Frequently asked questions
- What is Legacy Treatment Center LLC's NPI number?
- Legacy Treatment Center LLC's National Provider Identifier (NPI) is 1336940717, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Legacy Treatment Center LLC?
- Legacy Treatment Center LLC is classified in the NPPES registry as Addiction Medicine (Family Medicine) Physician (Allopathic & Osteopathic Physicians).
- Where is Legacy Treatment Center LLC located?
- Legacy Treatment Center LLC's practice location on file with NPPES is 3030 Lake Ave Ste 24, Fort Wayne, IN 46805-5428.
- What is Legacy Treatment Center LLC's phone number?
- The practice phone number listed in the NPPES registry for Legacy Treatment Center LLC is (260) 705-4587.
- Does Legacy Treatment Center LLC accept Medicare?
- Legacy Treatment Center LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Legacy Treatment Center LLC?
- The authorized official listed on Legacy Treatment Center LLC's NPPES record is Abdul Barrie, Ceo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Legacy Treatment Center LLC's NPI active?
- Yes — Legacy Treatment Center LLC's NPI (1336940717) is active in the NPPES registry as of the last update on 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.