NPI Code Detail JSON Logo

1194295089 NPI number — FREEDOM BRIDGE TO RECOVERY LLC

NPI Number: 1194295089
Health Care Provider/Practitioner: FREEDOM BRIDGE TO RECOVERY LLC

Information about “1194295089” NPI (FREEDOM BRIDGE TO RECOVERY LLC) exists in 1194295089 in HTML format HTML  |  1194295089 in plain Text format TXT  |  1194295089 in PDF (Portable Document Format) PDF  |  1194295089 in an XML format XML  formats.

NPI Number : 1194295089 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194295089",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FREEDOM BRIDGE TO RECOVERY 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": "1307 MAGNOLIA ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOWLING GREEN",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "42104-3050",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "270-791-9943",
    "MailingAddressFaxNumber": "270-904-2377",
    "FirstLinePracticeLocationAddress": "1307 MAGNOLIA ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOWLING GREEN",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "42104-3050",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "270-791-9943",
    "PracticeLocationAddressFaxNumber": "270-904-2377",
    "EnumerationDate": "12/04/2018",
    "LastUpdateDate": "12/13/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HENDERSHOT",
    "AuthorizedOfficialFirstName": "STACEY",
    "AuthorizedOfficialMiddleName": "DENISE",
    "AuthorizedOfficialTitle": "ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "270-791-9943",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QR0405X",
          "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "324500000X",
          "TaxonomyName": "Substance Abuse Rehabilitation Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.