MEDICARE: LEGACY COMMUNITY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942895792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY COMMUNITY CENTER LLC

Provider Business Mailing Address
First Line	:	10211 W SAMPLE RD STE 212214
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3972
Country	:	US
Telephone Number	:	954-603-7177
Fax Number	:	786-364-7543

Provider Business Practice Location Address
First Line	:	10211 W SAMPLE RD STE 212214
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3972
Country	:	US
Telephone Number	:	954-603-7177
Fax Number	:	786-364-7543

Authorized Official
Title or Position	:	CEO
Name	:	LISSETTE GARZON
Credential	:	BS, CBHCMS, CTP
Telephone Number	:	954-600-1728

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	06/24/2025

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Directions to “LEGACY COMMUNITY CENTER LLC ” Practice Location

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