NPI Code Detail JSON Logo

1174466999 NPI number — KBX PATHWAYS TO WELLNESS LLC

NPI Number: 1174466999
Health Care Provider/Practitioner: KBX PATHWAYS TO WELLNESS LLC

Information about “1174466999” NPI (KBX PATHWAYS TO WELLNESS LLC) exists in 1174466999 in HTML format HTML  |  1174466999 in plain Text format TXT  |  1174466999 in PDF (Portable Document Format) PDF  |  1174466999 in an XML format XML  formats.

NPI Number : 1174466999 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174466999",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KBX PATHWAYS TO WELLNESS 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": "4030 WAKE FOREST RD STE 349",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RALEIGH",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27609-0010",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-539-8762",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4030 WAKE FOREST RD STE 349",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RALEIGH",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27609-0010",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "919-539-8762",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2026",
    "LastUpdateDate": "04/14/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CHURCH-HINES",
    "AuthorizedOfficialFirstName": "KENI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CLINICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCMHC",
    "AuthorizedOfficialTelephoneNumber": "984-385-2650",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "175T00000X",
        "TaxonomyName": "Peer Specialist",
        "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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