| Legacy Community Center Llc | |
|
10211 W Sample Rd Ste 212214 Coral Springs FL 33065-3972 | |
| (954) 603-7177 | |
| (786) 364-7543 |
| Full Name | Legacy Community Center Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10211 W Sample Rd Ste 212214, Coral Springs, Florida |
| Authorized Official Name and Position | Lissette Garzon (PRESIDENT) |
| Authorized Official Contact | 9546001728 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Community Center Llc 10211 W Sample Rd Ste 212214 Coral Springs FL 33065-3972 Ph: (954) 603-7177 | Legacy Community Center Llc 10211 W Sample Rd Ste 212214 Coral Springs FL 33065-3972 Ph: (954) 603-7177 |
| NPI Number | 1942895792 |
|---|---|
| Provider Enumeration Date | 03/03/2021 |
| Last Update Date | 12/04/2023 |
| Certification Date | 12/04/2023 |
| Medicare PECOS PAC ID | 1355749201 |
|---|---|
| Medicare Enrollment ID | O20211007002567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942895792 | NPI | - | NPPES |
| Provider Name | Elizabeth A Gingerich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184246456 PECOS PAC ID: 1658783048 Enrollment ID: I20201208002694 |
| Provider Name | Sabih Iqbal |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1205330024 PECOS PAC ID: 5395141097 Enrollment ID: I20210903001578 |
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