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1376166637 NPI number — SPRINGFIELD ILLINOIS HOMECARE LLC

NPI Number: 1376166637
Health Care Provider/Practitioner: SPRINGFIELD ILLINOIS HOMECARE LLC

Information about “1376166637” NPI (SPRINGFIELD ILLINOIS HOMECARE LLC) exists in 1376166637 in HTML format HTML  |  1376166637 in plain Text format TXT  |  1376166637 in PDF (Portable Document Format) PDF  |  1376166637 in an XML format XML  formats.

NPI Number : 1376166637 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376166637",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SPRINGFIELD ILLINOIS HOMECARE LLC",
    "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": "2731 S MACARTHUR BLVD STE 201",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPRINGFIELD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62704-5081",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-299-2928",
    "MailingAddressFaxNumber": "217-568-6309",
    "FirstLinePracticeLocationAddress": "2731 S MACARTHUR BLVD STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPRINGFIELD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62704-5081",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-299-2928",
    "PracticeLocationAddressFaxNumber": "217-568-6309",
    "EnumerationDate": "05/21/2020",
    "LastUpdateDate": "08/17/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LANE",
    "AuthorizedOfficialFirstName": "ROD",
    "AuthorizedOfficialMiddleName": "A",
    "AuthorizedOfficialTitle": "OWNER/EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MBA",
    "AuthorizedOfficialTelephoneNumber": "217-299-2928",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "374U00000X",
          "TaxonomyName": "Home Health Aide",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "253Z00000X",
          "TaxonomyName": "In Home Supportive Care Agency",
          "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."
      }
    }
  }
}
                
            

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