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1104976356 NPI number — PINE LANE ESTATES LLC

NPI Number: 1104976356
Health Care Provider/Practitioner: PINE LANE ESTATES LLC

Information about “1104976356” NPI (PINE LANE ESTATES LLC) exists in 1104976356 in HTML format HTML  |  1104976356 in plain Text format TXT  |  1104976356 in PDF (Portable Document Format) PDF  |  1104976356 in an XML format XML  formats.

NPI Number : 1104976356 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104976356",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PINE LANE ESTATES 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": "2905 DOUGLAS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "YANKTON",
    "MailingAddressStateName": "SD",
    "MailingAddressPostalCode": "57078",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "605-665-7255",
    "MailingAddressFaxNumber": "605-668-2800",
    "FirstLinePracticeLocationAddress": "2905 DOUGLAS AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "YANKTON",
    "PracticeLocationAddressStateName": "SD",
    "PracticeLocationAddressPostalCode": "57078",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "605-665-7255",
    "PracticeLocationAddressFaxNumber": "605-668-2730",
    "EnumerationDate": "01/11/2007",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LOECKER",
    "AuthorizedOfficialFirstName": "DEANNA",
    "AuthorizedOfficialMiddleName": "JO",
    "AuthorizedOfficialTitle": "ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "605-665-7255",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "310400000X",
        "TaxonomyName": "Assisted Living Facility",
        "LicenseNumber": "46906",
        "LicenseNumberStateCode": "SD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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