Provider Demographics
NPI:1134465610
Name:LEGACY BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:LEGACY BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PAJARES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-722-7866
Mailing Address - Street 1:2640 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5931
Mailing Address - Country:US
Mailing Address - Phone:561-616-8411
Mailing Address - Fax:616-168-4125
Practice Address - Street 1:233 W AVENUE A STE C
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3092
Practice Address - Country:US
Practice Address - Phone:561-253-3679
Practice Address - Fax:561-253-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110114100Other91 - MEDICAID