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1174683874 NPI number — JACK JUDSON, LLC

NPI Number: 1174683874
Health Care Provider/Practitioner: JACK JUDSON, LLC

Information about “1174683874” NPI (JACK JUDSON, LLC) exists in 1174683874 in HTML format HTML  |  1174683874 in plain Text format TXT  |  1174683874 in PDF (Portable Document Format) PDF  |  1174683874 in an XML format XML  formats.

NPI Number : 1174683874 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174683874",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "JACK JUDSON, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4244 RIVER BIRCH RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WORTH",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76137-1132",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-847-5741",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4244 RIVER BIRCH RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT WORTH",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76137-1132",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-847-5741",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/11/2006",
    "LastUpdateDate": "06/19/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KIRKPATRICK",
    "AuthorizedOfficialFirstName": "ALICIA",
    "AuthorizedOfficialMiddleName": "G",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "817-847-5741",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "315P00000X",
        "TaxonomyName": "Intellectual Disabilities Intermediate Care Facility",
        "LicenseNumber": "007476",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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