Active NPI
Legacy 5 House
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Montgomery, TX
National Provider Identifier
1245149970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Legal business name
- LEGACY 5 HOUSE
- Practice address
- 611 Lake View Dr
Montgomery, TX 77356-4786 - Phone
- (480) 233-2712
- NPI assigned
- Sep 7, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mariea Jordan
- Title
- Owner
- Phone
- (480) 233-2712
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | Primary |
Addresses
Primary practice location
611 Lake View Dr
Montgomery, TX 77356-4786
Mailing address
611 Lake View Dr
Montgomery, TX 77356-4786
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788739200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1788739200000",
"number": "1245149970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 LAKE VIEW DR",
"city": "MONTGOMERY",
"state": "TX",
"postal_code": "773564786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 LAKE VIEW DR",
"city": "MONTGOMERY",
"state": "TX",
"postal_code": "773564786",
"telephone_number": "480-233-2712"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEGACY 5 HOUSE",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-07",
"last_updated": "2026-09-07",
"certification_date": "2026-09-07",
"status": "A",
"authorized_official_last_name": "JORDAN",
"authorized_official_first_name": "MARIEA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "480-233-2712"
},
"taxonomies": [
{
"code": "320600000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.