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1083073498 NPI number — DILLAHUNT ENTERPRISES, LLC

NPI Number: 1083073498
Health Care Provider/Practitioner: DILLAHUNT ENTERPRISES, LLC

Information about “1083073498” NPI (DILLAHUNT ENTERPRISES, LLC) exists in 1083073498 in HTML format HTML  |  1083073498 in plain Text format TXT  |  1083073498 in PDF (Portable Document Format) PDF  |  1083073498 in an XML format XML  formats.

NPI Number : 1083073498 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083073498",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DILLAHUNT ENTERPRISES, 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": "4300 ROYAL ABERDEEN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65203-4810",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "573-445-4408",
    "MailingAddressFaxNumber": "573-445-4408",
    "FirstLinePracticeLocationAddress": "4300 ROYAL ABERDEEN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65203-4810",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-445-4408",
    "PracticeLocationAddressFaxNumber": "573-445-4408",
    "EnumerationDate": "02/12/2016",
    "LastUpdateDate": "03/03/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DILLAHUNT",
    "AuthorizedOfficialFirstName": "NANCY",
    "AuthorizedOfficialMiddleName": "JANE",
    "AuthorizedOfficialTitle": "PROVIDER",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "573-445-4408",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "315P00000X",
          "TaxonomyName": "Intellectual Disabilities Intermediate Care Facility",
          "LicenseNumber": "093669",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320900000X",
          "TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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