NPI Code Detail JSON Logo

1245179019 NPI number — CAROLINA SUPPORTIVE LIVING LLC

NPI Number: 1245179019
Health Care Provider/Practitioner: CAROLINA SUPPORTIVE LIVING LLC

Information about “1245179019” NPI (CAROLINA SUPPORTIVE LIVING LLC) exists in 1245179019 in HTML format HTML  |  1245179019 in plain Text format TXT  |  1245179019 in PDF (Portable Document Format) PDF  |  1245179019 in an XML format XML  formats.

NPI Number : 1245179019 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245179019",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CAROLINA SUPPORTIVE LIVING 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": "1259 E MAIN ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OLD FORT",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28762-5768",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "828-470-8642",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1259 E MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OLD FORT",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28762-5768",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "828-470-8642",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/26/2026",
    "LastUpdateDate": "03/26/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PONDER",
    "AuthorizedOfficialFirstName": "OMECIA",
    "AuthorizedOfficialMiddleName": "MARGARITTA",
    "AuthorizedOfficialTitle": "OWNER/ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "828-747-5978",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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