NPI Code Detail JSON Logo

1003600800 NPI number — QUINCY MANOR LLC

NPI Number: 1003600800
Health Care Provider/Practitioner: QUINCY MANOR LLC

Information about “1003600800” NPI (QUINCY MANOR LLC) exists in 1003600800 in HTML format HTML  |  1003600800 in plain Text format TXT  |  1003600800 in PDF (Portable Document Format) PDF  |  1003600800 in an XML format XML  formats.

NPI Number : 1003600800 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003600800",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "QUINCY MANOR 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": "115 N CHESTER AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COMPTON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90221-2701",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-106-3599",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "115 N CHESTER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COMPTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90221-2701",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-106-3599",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/07/2025",
    "LastUpdateDate": "04/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HOGAN",
    "AuthorizedOfficialFirstName": "XAVIER",
    "AuthorizedOfficialMiddleName": "COSTOLINO",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": "SR.",
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "562-450-7211",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "313M00000X",
        "TaxonomyName": "Nursing Facility/Intermediate Care Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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