{
"Npi": {
"NPI": "1275923773",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GUAVA HOLDINGS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "262 N UNIVERSITY AVE STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FARMINGTON",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84025-2975",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1220 PLUMAS ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YUBA CITY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95991-3411",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "530-671-0550",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/04/2015",
"LastUpdateDate": "08/20/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MITCHELL",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SECRETARY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "385-988-3319",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "230000129",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}