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1114361102 NPI number — FONTHILL GARDENS INC

NPI Number: 1114361102
Health Care Provider/Practitioner: FONTHILL GARDENS INC

Information about “1114361102” NPI (FONTHILL GARDENS INC) exists in 1114361102 in HTML format HTML  |  1114361102 in plain Text format TXT  |  1114361102 in PDF (Portable Document Format) PDF  |  1114361102 in an XML format XML  formats.

NPI Number : 1114361102 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114361102",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FONTHILL GARDENS INC",
    "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": "14103 FONTHILL AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HAWTHORNE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90250-8013",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "310-973-7242",
    "MailingAddressFaxNumber": "310-973-7147",
    "FirstLinePracticeLocationAddress": "14103 FONTHILL AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HAWTHORNE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90250-8013",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-973-7242",
    "PracticeLocationAddressFaxNumber": "310-973-7147",
    "EnumerationDate": "04/22/2013",
    "LastUpdateDate": "04/22/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KHAN",
    "AuthorizedOfficialFirstName": "RAHMAT",
    "AuthorizedOfficialMiddleName": "HUSSAIN",
    "AuthorizedOfficialTitle": "C.E.O",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "FACS",
    "AuthorizedOfficialTelephoneNumber": "310-873-7242",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "323P00000X",
          "TaxonomyName": "Psychiatric Residential Treatment Facility",
          "LicenseNumber": "198204690",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3104A0625X",
          "TaxonomyName": "Assisted Living Facility (Mental Illness)",
          "LicenseNumber": "198204690",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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