Active NPI
Legacy Recovery Health Center
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Houston, TX
National Provider Identifier
1477993814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- License
- 10734
- Legal business name
- LEGACY RECOVERY HEALTH CENTER
- Practice address
- 388 W Little York Rd
Houston, TX 77076-1303 - Phone
- (713) 636-2964
- Fax
- (713) 636-9686
- NPI assigned
- Jun 30, 2013
- Last updated
- Mar 24, 2015
- 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
- Elijah Jacques, LCDC-I
- Title
- Executive Director
- Phone
- (713) 636-2964
Specialties & licenses 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | NU | ||
| Community/Behavioral Health Agency | 251S00000X | NU | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 10734 | TX | |
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | 10734 | TX | |
| Multi-Specialty Clinic/Center | 261QM1300X | 10734 | TX | |
| Rehabilitation Clinic/Center | 261QR0400X | 10734 | TX | |
| Adult Mental Health Clinic/Center | 261QM0850X | 10734 | TX | |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 10734 | TX | |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 3648-3655 | TX | |
| Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X | 10734 | TX | Primary |
Addresses
Primary practice location
388 W Little York Rd
Houston, TX 77076-1303
Mailing address
PO Box 3342
Spring, TX 77383-3342
Phone (713) 636-2964
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 326764301 | Medicaid | TX |
National Provider Directory
National Provider Directory- Tax ID family
- Legacy Recovery Health Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Counselor
- Houston, TX
- NPI 1972909646
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372550400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1427155200000",
"number": "1477993814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3342",
"city": "SPRING",
"state": "TX",
"postal_code": "773833342",
"telephone_number": "713-636-2964",
"fax_number": "713-636-9686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "388 W LITTLE YORK RD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770761303",
"telephone_number": "713-636-2964",
"fax_number": "713-636-9686"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEGACY RECOVERY HEALTH CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2013-06-30",
"last_updated": "2015-03-24",
"status": "A",
"authorized_official_last_name": "JACQUES",
"authorized_official_first_name": "ELIJAH",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "713-636-2964",
"authorized_official_credential": "LCDC-I"
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": "TX",
"license": "10734",
"primary": false
},
{
"code": "261QM0855X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adolescent and Children Mental Health",
"state": "TX",
"license": "10734",
"primary": false
},
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": "TX",
"license": "10734",
"primary": false
},
{
"code": "261QR0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation",
"state": "TX",
"license": "10734",
"primary": false
},
{
"code": "261QM0850X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adult Mental Health",
"state": "TX",
"license": "10734",
"primary": false
},
{
"code": "261QR0405X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
"state": "TX",
"license": "10734",
"primary": false
},
{
"code": "261QR0405X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
"state": "TX",
"license": "3648-3655",
"primary": false
},
{
"code": "261QR0401X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
"state": "TX",
"license": "10734",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "326764301",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
- Legacy Lights & Meters LLC (Trinity Clinical Group)
- Legacy Med LLC (KVA Pain Solution)
- Legacy Now Hospice, LLC
- Legacy Outreach Services
- Legacy Providers, LLC (Visiting Angels)
- Legacy Recovery Health Center
- Legacy Spa
- Legacy Speech Services L.L.C.
- Legacy Speech Services L.L.C.
- Legacycare LLC (Tabs Kitchen)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.