Integrated Legacy Support Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

INTEGRATED LEGACY SUPPORT SERVICES, LLC

Practice address

15526 W Rio Vista LN
Goodyear, AZ 85338-9441

Phone

(480) 516-6081

NPI assigned

Apr 15, 2024

Organization subpart

No

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

Authorized official

Name

Nashid Mateen

Title

Owner

Phone

(480) 516-6081

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1205680386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67472",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850827472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15526 W RIO VISTA LN",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853389441",
            "telephone_number": "480-516-6081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED LEGACY SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "MATEEN",
        "authorized_official_first_name": "NASHID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-516-6081"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.