Provider Demographics
NPI:1659024529
Name:LEGACY BEHAVIORAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:LEGACY BEHAVIORAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRSIDENT
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 1:518 SW PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8734
Mailing Address - Country:US
Mailing Address - Phone:772-873-8811
Mailing Address - Fax:772-873-8800
Practice Address - Street 1:1924 DAIRY RD
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4046
Practice Address - Country:US
Practice Address - Phone:321-256-8000
Practice Address - Fax:321-327-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management