NPI Code Detail JSON Logo

1306719679 NPI number — FULLER CARE LLC

NPI Number: 1306719679
Health Care Provider/Practitioner: FULLER CARE LLC

Information about “1306719679” NPI (FULLER CARE LLC) exists in 1306719679 in HTML format HTML  |  1306719679 in plain Text format TXT  |  1306719679 in PDF (Portable Document Format) PDF  |  1306719679 in an XML format XML  formats.

NPI Number : 1306719679 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306719679",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FULLER CARE 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": "1205 SENECA PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLENN HEIGHTS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75154-8821",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "972-754-7681",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1205 SENECA PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENN HEIGHTS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75154-8821",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "972-754-7681",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/24/2025",
    "LastUpdateDate": "09/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CHANCELLOR",
    "AuthorizedOfficialFirstName": "GERAD",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "469-337-3711",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251T00000X",
          "TaxonomyName": "PACE Provider Organization",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320700000X",
          "TaxonomyName": "Physical Disabilities Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "172V00000X",
          "TaxonomyName": "Community Health Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "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."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.