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1134676885 NPI number — OAK RIDGE DISTINCTIVE SENIOR LIVING AND REHAB, LLC

NPI Number: 1134676885
Health Care Provider/Practitioner: OAK RIDGE DISTINCTIVE SENIOR LIVING AND REHAB, LLC

Information about “1134676885” NPI (OAK RIDGE DISTINCTIVE SENIOR LIVING AND REHAB, LLC) exists in 1134676885 in HTML format HTML  |  1134676885 in plain Text format TXT  |  1134676885 in PDF (Portable Document Format) PDF  |  1134676885 in an XML format XML  formats.

NPI Number : 1134676885 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134676885",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "DISTINCTIVE SENIOR LIVING",
    "ParentOrgTIN": null,
    "OrgName": "OAK RIDGE DISTINCTIVE SENIOR LIVING AND REHAB, 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": "14615 MANCHESTER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANCHESTER",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63011-3790",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-225-7788",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "501 HUDSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EL DORADO",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "71730-6573",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-536-2776",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/09/2016",
    "LastUpdateDate": "09/09/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FORTE",
    "AuthorizedOfficialFirstName": "RODNEY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "SENIOR MEMBER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "618-889-3778",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "314000000X",
        "TaxonomyName": "Skilled Nursing Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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