Premium Legacy Healthcare Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PREMIUM LEGACY HEALTHCARE INC

Practice address

5062 N 19TH Ave Ste 102
Phoenix, AZ 85015-3225

Phone

(773) 319-6420

NPI assigned

Mar 27, 2023

Last updated

Jul 9, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ona Ekhomu, MBA

Title

Ceo

Phone

(773) 319-6420

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christian M Azode, APRN-PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1306492046
  Medicare reassignment NPD
• Ibukun Ajoke Fagbuyi, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Phoenix, AZ
  • NPI 1174280549
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752019200000",
    "number": "1184327249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11234 N 129TH WAY",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852594403",
            "telephone_number": "773-319-6420",
            "fax_number": "480-462-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5062 N 19TH AVE STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850153225",
            "telephone_number": "773-319-6420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM LEGACY HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-27",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A",
        "authorized_official_last_name": "EKHOMU",
        "authorized_official_first_name": "ONA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-319-6420",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premise Health of Arizona Medical PC (PGTI Wellness Center)
• Premise Health of Arizona Medical PC (USAA Phoenix)
• Premise Health of Arizona Medical, P.C. (Maricopa Health Center)
• Premium Behavior Clinic, LLC
• Premium Health Care Services
• Agnes J Premkumar, MD
• Arcot S Premkumar, MD
• Celina Premkumar
• Prempeh Home Care Services
• Jonathan William Prencipe, PHARMD

• Mental Health Clinic/Center (Including Community Mental Health Center) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.