NPI Code Detail JSON Logo

1114730553 NPI number — ANTELOPE VALLEY SUPPORTIVE CARE AND HOSPICE NON-PROFIT

NPI Number: 1114730553
Health Care Provider/Practitioner: ANTELOPE VALLEY SUPPORTIVE CARE AND HOSPICE NON-PROFIT

Information about “1114730553” NPI (ANTELOPE VALLEY SUPPORTIVE CARE AND HOSPICE NON-PROFIT) exists in 1114730553 in HTML format HTML  |  1114730553 in plain Text format TXT  |  1114730553 in PDF (Portable Document Format) PDF  |  1114730553 in an XML format XML  formats.

NPI Number : 1114730553 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114730553",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ANTELOPE VALLEY SUPPORTIVE CARE AND HOSPICE NON-PROFIT",
    "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": "1505 W AVENUE J STE 303",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LANCASTER",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93534-2845",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "661-247-8345",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1505 W AVENUE J STE 303",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LANCASTER",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93534-2845",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "661-247-8345",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/29/2025",
    "LastUpdateDate": "01/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KHODABAKHSH",
    "AuthorizedOfficialFirstName": "DANIEL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO / MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "661-247-8345",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251G00000X",
        "TaxonomyName": "Community Based Hospice Care Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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