NPI Code Detail JSON Logo

1356675433 NPI number — MALLORY'S HOME FOR THE AGED

NPI Number: 1356675433
Health Care Provider/Practitioner: MALLORY'S HOME FOR THE AGED

Information about “1356675433” NPI (MALLORY'S HOME FOR THE AGED) exists in 1356675433 in HTML format HTML  |  1356675433 in plain Text format TXT  |  1356675433 in PDF (Portable Document Format) PDF  |  1356675433 in an XML format XML  formats.

NPI Number : 1356675433 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356675433",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MALLORY'S HOME FOR THE AGED",
    "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": "3123 OVERBROOK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38128-4637",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-503-1505",
    "MailingAddressFaxNumber": "901-937-4887",
    "FirstLinePracticeLocationAddress": "207 WEST PERSON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38128-4637",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-503-1505",
    "PracticeLocationAddressFaxNumber": "901-937-4887",
    "EnumerationDate": "09/23/2009",
    "LastUpdateDate": "09/02/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MCGHEE",
    "AuthorizedOfficialFirstName": "LACRECIA",
    "AuthorizedOfficialMiddleName": "LASHUN",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "901-503-1505",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "320800000X",
        "TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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