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Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

LEGACY HEALTHCARE GROUP
NPI 1841108347
Nurse Practitioner - Psychiatric/Mental Health in Pocatello, ID

Active since August 28, 2026
5230 W MOONLIGHT MINE RD, POCATELLO, ID 83201(954) 548-7312(954) 548-7312 Get Directions Write a Review

NPPES record added: August 28, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

About Legacy Healthcare Group NPPES

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

LEGACY HEALTHCARE GROUP (NPI 1841108347) is a healthcare organization registered as a psychiatric/mental health in Pocatello, Idaho and active in the NPI registry since August 2026. The organization lists Everton Anthony Boothe, Owner, as its authorized official.

NPPES Registry Identity

NPI1841108347
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameLEGACY HEALTHCARE GROUP
Location Address5230 W MOONLIGHT MINE RDPocatello, ID 83201-9013
Mailing Address66 W Flagler St Ste 900Miami, FL 33130-1807 · (954) 548-7312 · Fax (954) 548-7312
Phone(954) 548-7312
Fax(954) 548-7312
Organization SubpartNo
Authorized OfficialEverton Anthony BootheOwner · (954) 548-7312
Enumeration DateAugust 28, 2026
NPPES CertifiedAugust 28, 2026
✔ NPI 1841108347 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
5230 W MOONLIGHT MINE RD, Pocatello, ID 83201
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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 3

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

ZACHARY KINNEY RECOVERY COACH
Peer Specialist
5230 W MOONLIGHT MINE RD
POCATELLO, ID 83201
Bannock County (208) 478-0219
EMILY K FLINT LPC
Counselor (Mental Health)
5230 W MOONLIGHT MINE RD
POCATELLO, ID 83201
Bannock County (208) 505-9990
MOONLIGHT MOUNTAIN RECOVERY, INC
Substance Abuse Rehabilitation Facility
5230 W MOONLIGHT MINE RD
POCATELLO, ID 83201
Bannock County (208) 505-9990

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 Legacy Healthcare Group's NPI number?

The NPI number for Legacy Healthcare Group is 1841108347. It was assigned to this organization in the NPPES registry on August 28, 2026.

Where is Legacy Healthcare Group located?

Legacy Healthcare Group is located at 5230 W Moonlight Mine Rd, Pocatello, ID 83201. The listed phone number is (954) 548-7312.

What is Legacy Healthcare Group's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Legacy Healthcare Group was last updated on August 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 days 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.