| Premium Legacy Healthcare Inc | |
|
5062 N 19th Ave Ste 102 Phoenix AZ 85015-3225 | |
| (773) 319-6420 | |
| Not Available |
| Full Name | Premium Legacy Healthcare Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5062 N 19th Ave Ste 102, Phoenix, Arizona |
| Authorized Official Name and Position | Ona Ekhomu (CEO) |
| Authorized Official Contact | 7733196420 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premium Legacy Healthcare Inc 15255 N Frank Lloyd Wright Blvd Apt 1025 Scottsdale AZ 85260-2803 Ph: (773) 319-6420 | Premium Legacy Healthcare Inc 5062 N 19th Ave Ste 102 Phoenix AZ 85015-3225 Ph: (773) 319-6420 |
| NPI Number | 1184327249 |
|---|---|
| Provider Enumeration Date | 03/27/2023 |
| Last Update Date | 10/04/2024 |
| Certification Date | 10/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184327249 | NPI | - | NPPES |
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