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PREMIUM LEGACY HEALTHCARE INC
NPI 1184327249
Clinic/Center - Mental Health (Including Community Mental Health Center) in Phoenix, AZ

Active since March 27, 2023
5062 N 19TH AVE STE 102, PHOENIX, AZ 85015(773) 319-6420 Get Directions Write a Review

NPPES record last updated: July 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 9, 2025, Oct 4, 2024, Mar 27, 2023 (3 updates tracked since 2023).

About Premium Legacy Healthcare Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PREMIUM LEGACY HEALTHCARE INC (NPI 1184327249) is a healthcare organization registered as a mental health (including community mental health center) in Phoenix, Arizona and active in the NPI registry since March 2023. The organization lists Ona Ekhomu, Ceo, as its authorized official.

NPPES Registry Identity

NPI1184327249
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NamePREMIUM LEGACY HEALTHCARE INC
Location Address5062 N 19TH AVE STE 102Phoenix, AZ 85015-3225
Mailing Address11234 N 129th WayScottsdale, AZ 85259-4403 · (773) 319-6420 · Fax (480) 462-5090
Phone(773) 319-6420
Organization SubpartNo
Authorized OfficialOna EkhomuCeo · (773) 319-6420
Enumeration DateMarch 27, 2023
Last NPPES UpdateJuly 9, 20253 updates tracked since enumeration
NPPES CertifiedJuly 9, 2025
✔ NPI 1184327249 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X
5062 N 19TH AVE STE 102, Phoenix, AZ 85015
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

XAVIER LEWIS JENKINS COUNSELOR
Counselor (Addiction (Substance Use Disorder))
5062 N 19TH AVE STE 102
PHOENIX, AZ 85015
Maricopa County (480) 629-5994
NEW HORIZONS COUNSELING SERVICE INC.
Community/Behavioral Health
5062 N 19TH AVE STE 102
PHOENIX, AZ 85015
Maricopa County (623) 939-6567
COMMUNITY SUPPORT SERVICES, INC.
Community/Behavioral Health
5062 N 19TH AVE STE 102
PHOENIX, AZ 85015
Maricopa County (480) 629-5994
DR. GREGORY WAUGH PSY.D
Psychologist (Clinical)
5062 N 19TH AVE STE 102
PHOENIX, AZ 85015
Maricopa County (623) 939-6567

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Premium Legacy Healthcare Inc's NPI number?

The NPI number for Premium Legacy Healthcare Inc is 1184327249. It was assigned to this organization in the NPPES registry on March 27, 2023.

Where is Premium Legacy Healthcare Inc located?

Premium Legacy Healthcare Inc is located at 5062 N 19th Ave Ste 102, Phoenix, AZ 85015. The listed phone number is (773) 319-6420.

What is Premium Legacy Healthcare Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

When was this NPI record last updated?

The NPPES record for Premium Legacy Healthcare Inc was last updated on July 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.