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1083428734 NPI number — CRITTENTON SERVICES

NPI Number: 1083428734
Health Care Provider/Practitioner: CRITTENTON SERVICES

Information about “1083428734” NPI (CRITTENTON SERVICES) exists in 1083428734 in HTML format HTML  |  1083428734 in plain Text format TXT  |  1083428734 in PDF (Portable Document Format) PDF  |  1083428734 in an XML format XML  formats.

NPI Number : 1083428734 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083428734",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CRITTENTON SERVICES",
    "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": "761 3RD ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEW MARTINSVILLE",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "26155-1403",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "304-455-3035",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "761 3RD ST # 1403",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW MARTINSVILLE",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "26155-1403",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-455-3035",
    "PracticeLocationAddressFaxNumber": "304-455-3035",
    "EnumerationDate": "02/04/2025",
    "LastUpdateDate": "02/04/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KOCHER",
    "AuthorizedOfficialFirstName": "BRANDY",
    "AuthorizedOfficialMiddleName": "MICHELLE",
    "AuthorizedOfficialTitle": "COMMUNITY LIAISON",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RBA",
    "AuthorizedOfficialTelephoneNumber": "304-455-3035",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM0850X",
          "TaxonomyName": "Adult Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "172V00000X",
          "TaxonomyName": "Community Health Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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