Healthcare Provider Details

I. General information

NPI: 1063189546
Provider Name (Legal Business Name): LEGACY BEHAVIORAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 NW 5TH ST
OKEECHOBEE FL
34972-2565
US

IV. Provider business mailing address

2640 FOREST HILL BLVD
WEST PALM BEACH FL
33406-5931
US

V. Phone/Fax

Practice location:
  • Phone: 863-357-8268
  • Fax: 863-357-8269
Mailing address:
  • Phone: 561-616-8411
  • Fax: 561-616-8412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ALICIA B. PAJARES
Title or Position: PRESIDENT
Credential:
Phone: 561-722-7866