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1104742790 NPI number — SHIRLEY'S ENRICHMENT HOUSE, LLC

NPI Number: 1104742790
Health Care Provider/Practitioner: SHIRLEY'S ENRICHMENT HOUSE, LLC

Information about “1104742790” NPI (SHIRLEY'S ENRICHMENT HOUSE, LLC) exists in 1104742790 in HTML format HTML  |  1104742790 in plain Text format TXT  |  1104742790 in PDF (Portable Document Format) PDF  |  1104742790 in an XML format XML  formats.

NPI Number : 1104742790 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104742790",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SHIRLEY'S ENRICHMENT HOUSE, 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": "169 TACKLE BOX DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TROUTMAN",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28166-0140",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-291-1454",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "169 TACKLE BOX DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TROUTMAN",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28166-0140",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-291-1454",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/26/2026",
    "LastUpdateDate": "06/26/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GUINYARD",
    "AuthorizedOfficialFirstName": "CHRYSTAL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "704-291-1454",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "320800000X",
        "TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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