Provider Demographics
NPI:1073710471
Name:LEGACY BEHAVIORAL SERVICES INC
Entity Type:Organization
Organization Name:LEGACY BEHAVIORAL SERVICES INC
Other - Org Name:LEGACY FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-861-1133
Mailing Address - Street 1:1800 WESTWIND DR STE 107
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3031
Mailing Address - Country:US
Mailing Address - Phone:661-472-3698
Mailing Address - Fax:661-861-1144
Practice Address - Street 1:1800 WESTWIND DR STE 107
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3031
Practice Address - Country:US
Practice Address - Phone:661-472-3698
Practice Address - Fax:661-861-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING251S00000X
251S00000X, 253J00000X, 261QM0801X, 261QM0850X, 261QM0855X
CA150039324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1577Medicare ID - Type UnspecifiedDRUG MEDI-CAL