NPI Code Detail JSON Logo

1063724870 NPI number — LEISURE LIVING MANAGEMENT OF PORTAGE, INC.

NPI Number: 1063724870
Health Care Provider/Practitioner: LEISURE LIVING MANAGEMENT OF PORTAGE, INC.

Information about “1063724870” NPI (LEISURE LIVING MANAGEMENT OF PORTAGE, INC.) exists in 1063724870 in HTML format HTML  |  1063724870 in plain Text format TXT  |  1063724870 in PDF (Portable Document Format) PDF  |  1063724870 in an XML format XML  formats.

NPI Number : 1063724870 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063724870",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LEISURE LIVING MANAGEMENT OF PORTAGE, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7818 KENMURE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTAGE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49024-5082",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "269-327-9595",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7818 KENMURE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTAGE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49024-5082",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "269-327-9595",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/09/2010",
    "LastUpdateDate": "07/09/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "NOBEL",
    "AuthorizedOfficialFirstName": "THOMAS",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "269-327-9595",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "291U00000X",
        "TaxonomyName": "Clinical Medical Laboratory",
        "LicenseNumber": "23D0975380",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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