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Organization
LEGACY BEHAVIORAL HEALTH CENTER
Active
Organization
LEGACY BEHAVIORAL HEALTH CENTER
Active
Parent organization
LEGACY BEHAVIORAL HEALTH CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
LEGACY BEHAVIORAL HEALTH CENTER
Authorized official
IVAN RAFAEL JIMENEZ (HR DIRECTOR)
(561) 253-1770
Entity
Organization
Contact information
Practice address
518 SW PRIMA VISTA BLVD, PORT ST LUCIE, FL 34983-8734
(772) 873-8811
(772) 873-8800
Mailing address
518 SW PRIMA VISTA BLVD, PORT ST LUCIE, FL 34983-8734
(772) 873-8811
(772) 873-8800
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
10/25/2024
Last updated
10/25/2024
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