NPI Code Detail JSON Logo

1275153579 NPI number — LIFE CARE 360, LLC

NPI Number: 1275153579
Health Care Provider/Practitioner: LIFE CARE 360, LLC

Information about “1275153579” NPI (LIFE CARE 360, LLC) exists in 1275153579 in HTML format HTML  |  1275153579 in plain Text format TXT  |  1275153579 in PDF (Portable Document Format) PDF  |  1275153579 in an XML format XML  formats.

NPI Number : 1275153579 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275153579",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LIFE CARE 360, 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": "12914 BROADWAY AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GARFIELD HEIGHTS",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44125-1859",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "216-848-9123",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12914 BROADWAY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GARFIELD HEIGHTS",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44125-1859",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "216-848-9123",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/16/2020",
    "LastUpdateDate": "04/16/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VANCE-ANDERSON",
    "AuthorizedOfficialFirstName": "KENYATTA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "216-848-9123",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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