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1215522263 NPI number — REVIVE RECOVERY LLC

NPI Number: 1215522263
Health Care Provider/Practitioner: REVIVE RECOVERY LLC

Information about “1215522263” NPI (REVIVE RECOVERY LLC) exists in 1215522263 in HTML format HTML  |  1215522263 in plain Text format TXT  |  1215522263 in PDF (Portable Document Format) PDF  |  1215522263 in an XML format XML  formats.

NPI Number : 1215522263 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215522263",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "REVIVE 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": "3541 BONITA BAY BLVD STE 200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BONITA SPRINGS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34134-1703",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "239-908-9958",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3541 BONITA BAY BLVD STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BONITA SPRINGS",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34134-1703",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "239-908-9958",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/02/2021",
    "LastUpdateDate": "03/02/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "THOMAS",
    "AuthorizedOfficialFirstName": "CHRISTINA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "239-908-9958",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QI0500X",
          "TaxonomyName": "Infusion Therapy Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0850X",
          "TaxonomyName": "Adult Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0855X",
          "TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261Q00000X",
          "TaxonomyName": "Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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