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1073774436 NPI number — SJV 1 EDMONDS OPCO LLC

NPI Number: 1073774436
Health Care Provider/Practitioner: SJV 1 EDMONDS OPCO LLC

Information about “1073774436” NPI (SJV 1 EDMONDS OPCO LLC) exists in 1073774436 in HTML format HTML  |  1073774436 in plain Text format TXT  |  1073774436 in PDF (Portable Document Format) PDF  |  1073774436 in an XML format XML  formats.

NPI Number : 1073774436 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073774436",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SJV 1 EDMONDS OPCO LLC",
    "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": "750 EDMONDS WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EDMONDS",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98020-5126",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "425-673-9700",
    "MailingAddressFaxNumber": "425-673-9701",
    "FirstLinePracticeLocationAddress": "750 EDMONDS WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EDMONDS",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98020-5126",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "425-673-9700",
    "PracticeLocationAddressFaxNumber": "425-673-9701",
    "EnumerationDate": "06/18/2008",
    "LastUpdateDate": "12/16/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HARRIS",
    "AuthorizedOfficialFirstName": "TONY",
    "AuthorizedOfficialMiddleName": "J.",
    "AuthorizedOfficialTitle": "SENIOR REIMBURSEMENT MANAGER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "703-854-0830",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "311500000X",
          "TaxonomyName": "Alzheimer Center (Dementia Center)",
          "LicenseNumber": "1740",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "310400000X",
          "TaxonomyName": "Assisted Living Facility",
          "LicenseNumber": "1740",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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