NPI Code Detail JSON Logo

1275052029 NPI number — DESTINED 2 GROW LLC.

NPI Number: 1275052029
Health Care Provider/Practitioner: DESTINED 2 GROW LLC.

Information about “1275052029” NPI (DESTINED 2 GROW LLC.) exists in 1275052029 in HTML format HTML  |  1275052029 in plain Text format TXT  |  1275052029 in PDF (Portable Document Format) PDF  |  1275052029 in an XML format XML  formats.

NPI Number : 1275052029 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275052029",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DESTINED 2 GROW 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": "1 RALSTON WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MONROE TOWNSHIP",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08831-2901",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "732-710-1804",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1 RALSTON WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MONROE TOWNSHIP",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08831-2901",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "732-710-1804",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/13/2017",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHEGBONE",
    "AuthorizedOfficialFirstName": "ELSIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "SPECIAL EDUCATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MSED",
    "AuthorizedOfficialTelephoneNumber": "732-710-1804",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "252Y00000X",
        "TaxonomyName": "Early Intervention Provider Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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