| NPI | 1144386442 |
|---|---|
| Doing Business As | LEGION AVENUE CLINIC |
| Entity Type | Organization |
| Authorized Contact | LYNN M MADDEN President/Chief Executive Officer 203-781-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: CT 0230) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2017-02-21 |