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1174439798 NPI number — THREE SHORES HEALTH CARE

NPI Number: 1174439798
Health Care Provider/Practitioner: THREE SHORES HEALTH CARE

Information about “1174439798” NPI (THREE SHORES HEALTH CARE) exists in 1174439798 in HTML format HTML  |  1174439798 in plain Text format TXT  |  1174439798 in PDF (Portable Document Format) PDF  |  1174439798 in an XML format XML  formats.

NPI Number : 1174439798 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174439798",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THREE SHORES HEALTH CARE",
    "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": "8000 WARREN WOODS RD LOT 68",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "THREE OAKS",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49128-9573",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "574-220-4676",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8000 WARREN WOODS RD LOT 68",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "THREE OAKS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49128-9573",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "574-220-4676",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/22/2026",
    "LastUpdateDate": "08/22/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DECOCKER",
    "AuthorizedOfficialFirstName": "KAREN",
    "AuthorizedOfficialMiddleName": "ANN",
    "AuthorizedOfficialTitle": "OWNER/PROVIDER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DNP, PMHNP-BC",
    "AuthorizedOfficialTelephoneNumber": "574-220-4676",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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