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1245754084 NPI number — SOUL HOUSE CRUBER WELLNESS CENTER

NPI Number: 1245754084
Health Care Provider/Practitioner: SOUL HOUSE CRUBER WELLNESS CENTER

Information about “1245754084” NPI (SOUL HOUSE CRUBER WELLNESS CENTER) exists in 1245754084 in HTML format HTML  |  1245754084 in plain Text format TXT  |  1245754084 in PDF (Portable Document Format) PDF  |  1245754084 in an XML format XML  formats.

NPI Number : 1245754084 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245754084",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SOUL HOUSE CRUBER WELLNESS CENTER",
    "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": "1144 CLINTON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IRVINGTON",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07111-2045",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "862-218-6710",
    "MailingAddressFaxNumber": "973-399-3613",
    "FirstLinePracticeLocationAddress": "1144 CLINTON AVENUE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "IRVINGTON",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07111",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "862-218-6710",
    "PracticeLocationAddressFaxNumber": "973-399-3613",
    "EnumerationDate": "08/02/2017",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RASHID",
    "AuthorizedOfficialFirstName": "ALI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MBA",
    "AuthorizedOfficialTelephoneNumber": "973-399-3100",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "37LC00170100",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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