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1336781293 NPI number — LAKE COUNTY CRISIS CENTER FOR THE PREVENTION AND TREATMENT OF DOMESTIC

NPI Number: 1336781293
Health Care Provider/Practitioner: LAKE COUNTY CRISIS CENTER FOR THE PREVENTION AND TREATMENT OF DOMESTIC

Information about “1336781293” NPI (LAKE COUNTY CRISIS CENTER FOR THE PREVENTION AND TREATMENT OF DOMESTIC) exists in 1336781293 in HTML format HTML  |  1336781293 in plain Text format TXT  |  1336781293 in PDF (Portable Document Format) PDF  |  1336781293 in an XML format XML  formats.

NPI Number : 1336781293 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336781293",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LAKE COUNTY CRISIS CENTER FOR THE PREVENTION AND TREATMENT OF DOMESTIC",
    "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": "2710 17TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ZION",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60099-1543",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-731-7165",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2710 17TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ZION",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60099-1543",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-731-7165",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/11/2019",
    "LastUpdateDate": "12/06/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DAVENPORT",
    "AuthorizedOfficialFirstName": "PAT",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "847-731-7165",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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