NPI Code Detail JSON Logo

1235725516 NPI number — ROOTS 45

NPI Number: 1235725516
Health Care Provider/Practitioner: ROOTS 45

Information about “1235725516” NPI (ROOTS 45) exists in 1235725516 in HTML format HTML  |  1235725516 in plain Text format TXT  |  1235725516 in PDF (Portable Document Format) PDF  |  1235725516 in an XML format XML  formats.

NPI Number : 1235725516 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235725516",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ROOTS 45",
    "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": "2704 HICKORYWOOD DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GAYLORD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49735-6403",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "989-350-3053",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 W 1ST ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GAYLORD",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49735-1355",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "989-350-3053",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/21/2020",
    "LastUpdateDate": "12/21/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WUMMEL",
    "AuthorizedOfficialFirstName": "JENNIFER",
    "AuthorizedOfficialMiddleName": "ELLEN",
    "AuthorizedOfficialTitle": "BH THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LMSW",
    "AuthorizedOfficialTelephoneNumber": "989-350-3053",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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