NPI Code Detail JSON Logo

1366323800 NPI number — FLORIDA MENTOR II LLC

NPI Number: 1366323800
Health Care Provider/Practitioner: FLORIDA MENTOR II LLC

Information about “1366323800” NPI (FLORIDA MENTOR II LLC) exists in 1366323800 in HTML format HTML  |  1366323800 in plain Text format TXT  |  1366323800 in PDF (Portable Document Format) PDF  |  1366323800 in an XML format XML  formats.

NPI Number : 1366323800 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366323800",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FLORIDA MENTOR II 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": "6600 FRANCE AVE S STE 350",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EDINA",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55435-1810",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "800-388-5150",
    "MailingAddressFaxNumber": "952-922-6885",
    "FirstLinePracticeLocationAddress": "5802 BRECKENRIDGE PKWY STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TAMPA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33610-4265",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "800-388-5150",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/10/2025",
    "LastUpdateDate": "09/10/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RODENBERG-ROBERTS",
    "AuthorizedOfficialFirstName": "MARY",
    "AuthorizedOfficialMiddleName": "PATRICIA",
    "AuthorizedOfficialTitle": "VP & SR ASST GENERAL COUNSEL",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "952-836-2234",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QD1600X",
          "TaxonomyName": "Developmental Disabilities Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320600000X",
          "TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320900000X",
          "TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "253Z00000X",
          "TaxonomyName": "In Home Supportive Care Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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