# LEGACY HEALTHCARE GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841108347
- **Authorized official:** MR. EVERTON ANTHONY BOOTHE PMHNP-BC (OWNER)
- **Authorized official phone:** (954) 548-7312

## Contact information

- **Practice address:** 5230 W MOONLIGHT MINE RD, POCATELLO, ID 83201-9013
- **Practice address phone:** (954) 548-7312
- **Practice address fax:** (954) 548-7312
- **Mailing address:** 66 W FLAGLER ST STE 900, MIAMI, FL 33130-1807
- **Mailing address phone:** (954) 548-7312
- **Mailing address fax:** (954) 548-7312

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/28/2026
- **Last updated:** 08/28/2026