Provider Demographics
NPI:1073193991
Name:BLESSED LEGACY LLC
Entity Type:Organization
Organization Name:BLESSED LEGACY LLC
Other - Org Name:LIFE SKILLS ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ-PITA
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:954-638-3770
Mailing Address - Street 1:4302 GULFWINDS DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2744
Mailing Address - Country:US
Mailing Address - Phone:954-638-3770
Mailing Address - Fax:
Practice Address - Street 1:4302 GULFWINDS DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-2744
Practice Address - Country:US
Practice Address - Phone:954-638-3770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty