NPI Code Detail JSON Logo

1306300694 NPI number — DIVINE REHABILITATION AND NURSING AT FENNIMORE LLC

NPI Number: 1306300694
Health Care Provider/Practitioner: DIVINE REHABILITATION AND NURSING AT FENNIMORE LLC

Information about “1306300694” NPI (DIVINE REHABILITATION AND NURSING AT FENNIMORE LLC) exists in 1306300694 in HTML format HTML  |  1306300694 in plain Text format TXT  |  1306300694 in PDF (Portable Document Format) PDF  |  1306300694 in an XML format XML  formats.

NPI Number : 1306300694 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306300694",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DIVINE REHABILITATION AND NURSING AT FENNIMORE 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": "1632 61ST ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROOKLYN",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11204-2109",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "608-448-6200",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1850 11TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FENNIMORE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53809-1612",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-822-6100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/30/2019",
    "LastUpdateDate": "01/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MARKOVITS",
    "AuthorizedOfficialFirstName": "ISAAK",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "718-753-0250",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "314000000X",
        "TaxonomyName": "Skilled Nursing Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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