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1003321696 NPI number — GRACE COTTAGE LLC

NPI Number: 1003321696
Health Care Provider/Practitioner: GRACE COTTAGE LLC

Information about “1003321696” NPI (GRACE COTTAGE LLC) exists in 1003321696 in HTML format HTML  |  1003321696 in plain Text format TXT  |  1003321696 in PDF (Portable Document Format) PDF  |  1003321696 in an XML format XML  formats.

NPI Number : 1003321696 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003321696",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "GRACE COTTAGE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "531 N CRESTLINE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WICHITA",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "67212-4618",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "316-990-2366",
    "MailingAddressFaxNumber": "316-990-2373",
    "FirstLinePracticeLocationAddress": "531 N CRESTLINE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WICHITA",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "67212-4618",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "316-990-2366",
    "PracticeLocationAddressFaxNumber": "316-990-2373",
    "EnumerationDate": "12/05/2017",
    "LastUpdateDate": "12/05/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LEHMAN",
    "AuthorizedOfficialFirstName": "REGINA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DON/OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "BSN RN",
    "AuthorizedOfficialTelephoneNumber": "316-990-2366",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "310400000X",
        "TaxonomyName": "Assisted Living Facility",
        "LicenseNumber": "B087219",
        "LicenseNumberStateCode": "KS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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