NPI Code Detail JSON Logo

1033795794 NPI number — SERENITY @ SHILOH LLC

NPI Number: 1033795794
Health Care Provider/Practitioner: SERENITY @ SHILOH LLC

Information about “1033795794” NPI (SERENITY @ SHILOH LLC) exists in 1033795794 in HTML format HTML  |  1033795794 in plain Text format TXT  |  1033795794 in PDF (Portable Document Format) PDF  |  1033795794 in an XML format XML  formats.

NPI Number : 1033795794 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033795794",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SERENITY @ SHILOH 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": "4700 PENNOAK LN APT K",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENSBORO",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27407-4097",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-880-5836",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1105 COLONIAL AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREENVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27834-1828",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-365-8466",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/23/2021",
    "LastUpdateDate": "03/23/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FAULK",
    "AuthorizedOfficialFirstName": "JANESHA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO/DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "919-880-5836",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "385H00000X",
          "TaxonomyName": "Respite Care",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "385HR2055X",
          "TaxonomyName": "Child Mental Illness Respite Care",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320800000X",
          "TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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