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1114685880 NPI number — BRIGHT STAR BEHAVIORAL, LLC

NPI Number: 1114685880
Health Care Provider/Practitioner: BRIGHT STAR BEHAVIORAL, LLC

Information about “1114685880” NPI (BRIGHT STAR BEHAVIORAL, LLC) exists in 1114685880 in HTML format HTML  |  1114685880 in plain Text format TXT  |  1114685880 in PDF (Portable Document Format) PDF  |  1114685880 in an XML format XML  formats.

NPI Number : 1114685880 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114685880",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BRIGHT STAR BEHAVIORAL, 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": "110 ARMISTICE BLVD STE 3",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PAWTUCKET",
    "MailingAddressStateName": "RI",
    "MailingAddressPostalCode": "02860-5354",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "508-762-7344",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "110 ARMISTICE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PAWTUCKET",
    "PracticeLocationAddressStateName": "RI",
    "PracticeLocationAddressPostalCode": "02860-5354",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "508-762-7344",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/30/2021",
    "LastUpdateDate": "10/11/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ANTWI",
    "AuthorizedOfficialFirstName": "REBECCA",
    "AuthorizedOfficialMiddleName": "FREMPONG",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PMHNP",
    "AuthorizedOfficialTelephoneNumber": "509-762-7344",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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