NPIMap

Organization Active NPI

Legacy Behavioral Health Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Indiantown, FL
National Provider Identifier
1568439685
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LEGACY BEHAVIORAL HEALTH CENTER INC
Practice address
15818 SW Warfield Blvd
Indiantown, FL 34956-3513
Phone
(772) 597-0411
Fax
(772) 597-0412
NPI assigned
Mar 7, 2006
Last updated
Feb 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Authorized official

Name
Ms. Alicia B. Pajares, LCSWNPI 1659357903
Title
President
Phone
(561) 722-7866

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW5271 FL
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Community/Behavioral Health Agency 251S00000X 6427 FL

Addresses

Primary practice location

15818 SW Warfield Blvd
Indiantown, FL 34956-3513

Mailing address

PO Box 458
Indiantown, FL 34956-0458
Phone (772) 597-0411

Other identifiers 2

IdentifierTypeStateIssuer
600058153OtherFLMAGELLAN HMO
076140100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090428000101 FL Part B Supplier - Clinic/Group Practice 3072677756 Receives reassigned benefits from 20 practitioners
7 other NPIs on this enrollment
Practice locations: Indiantown, FL; Okeechobee, FL; Port Saint Lucie, FL; Stuart, FL; Vero Beach, FL; West Melbourne, FL

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Legacy Behavioral Health Center Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

304 NW 5th St
#300
Okeechobee, FL 34972
Phone (863) 357-8268

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1568439685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "INDIANTOWN",
            "state": "FL",
            "postal_code": "349560458",
            "telephone_number": "772-597-0411",
            "fax_number": "772-597-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15818 SW WARFIELD BLVD",
            "city": "INDIANTOWN",
            "state": "FL",
            "postal_code": "349563513",
            "telephone_number": "772-597-0411",
            "fax_number": "772-597-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY BEHAVIORAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "PAJARES",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-722-7866",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW5271",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "6427",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN HMO",
            "identifier": "600058153",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076140100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indiantown, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; 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.