MEDICARE: BLESSED LEGACY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1073193991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLESSED LEGACY LLC

Provider Business Mailing Address
First Line	:	2072 MAGUIRE AVE
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-5037
Country	:	US
Telephone Number	:	954-638-3770
Fax Number	:

Provider Business Practice Location Address
First Line	:	2072 MAGUIRE AVE
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-5037
Country	:	US
Telephone Number	:	813-756-8056
Fax Number	:	813-725-6424

Authorized Official
Title or Position	:	OWNER
Name	:	YADIRA SUAREZ-PITA
Credential	:	MS.ED., BCBA
Telephone Number	:	954-638-3770

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	08/01/2025

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Directions to “BLESSED LEGACY LLC ” Practice Location

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