NPIMap

Organization Active NPI

Legacy Behavioral Health Center Inc

  • Community/Behavioral Health Agency
  • Port Saint Lucie, FL
National Provider Identifier
1942977426
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LEGACY BEHAVIORAL HEALTH CENTER INC
Practice address
518 SW Prima Vista Blvd
Port Saint Lucie, FL 34983-8734
Phone
(772) 873-8811
Fax
(772) 873-8800
NPI assigned
Aug 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

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

Mailing address

2640 Forest Hill Blvd
West Palm Beach, FL 33406-5931
Phone (561) 616-8411

Other identifiers 1

IdentifierTypeStateIssuer
076140103MedicaidFL

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
This NPI is an additional NPI on the 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

NPI Registry JSON

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629763200000",
    "number": "1942977426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2640 FOREST HILL BLVD",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334065931",
            "telephone_number": "561-616-8411",
            "fax_number": "561-616-8412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 SW PRIMA VISTA BLVD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349838734",
            "telephone_number": "772-873-8811",
            "fax_number": "772-873-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY BEHAVIORAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-24",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "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": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076140103",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; 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.