NPIMap

Organization Active NPI

Legacy Behavioral Health Center

  • Behavior Analyst
  • Port St Lucie, FL
National Provider Identifier
1659193357
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
LEGACY BEHAVIORAL HEALTH CENTER
Practice address
518 SW Prima Vista Blvd
Port St Lucie, FL 34983-8734
Phone
(772) 873-8811
Fax
(772) 873-8800
NPI assigned
Oct 25, 2024
Organization subpart
Yes
Parent organization
LEGACY BEHAVIORAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Authorized official

Name
Ivan Rafael Jimenez
Title
HR Director
Phone
(561) 253-1770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

518 SW Prima Vista Blvd
Port St Lucie, FL 34983-8734

Mailing address

518 SW Prima Vista Blvd
Port St Lucie, FL 34983-8734
Phone (772) 873-8811

National Provider Directory

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

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1659193357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 SW PRIMA VISTA BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349838734",
            "telephone_number": "772-873-8811",
            "fax_number": "772-873-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 SW PRIMA VISTA BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349838734",
            "telephone_number": "772-873-8811",
            "fax_number": "772-873-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY BEHAVIORAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY BEHAVIORAL HEALTH CENTER",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "RAFAEL",
        "authorized_official_title_or_position": "HR DIRECTOR",
        "authorized_official_telephone_number": "561-253-1770"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.