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1174169759 NPI number — JLW HEALTHCARE LLC

NPI Number: 1174169759
Health Care Provider/Practitioner: JLW HEALTHCARE LLC

Information about “1174169759” NPI (JLW HEALTHCARE LLC) exists in 1174169759 in HTML format HTML  |  1174169759 in plain Text format TXT  |  1174169759 in PDF (Portable Document Format) PDF  |  1174169759 in an XML format XML  formats.

NPI Number : 1174169759 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174169759",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "JLW HEALTHCARE 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": "3621 N PACIFIC COAST CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAUDERDALE LAKES",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33309-2262",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "561-828-9191",
    "MailingAddressFaxNumber": "954-900-1573",
    "FirstLinePracticeLocationAddress": "10556 LAKE JASMINE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOCA RATON",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33498-1616",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-603-1445",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/19/2019",
    "LastUpdateDate": "10/02/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RIVERA",
    "AuthorizedOfficialFirstName": "MARIA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "855-541-5461",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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