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1386029973 NPI number — PENNYWELL BEHAVIORAL HEALTH CENTER

NPI Number: 1386029973
Health Care Provider/Practitioner: PENNYWELL BEHAVIORAL HEALTH CENTER

Information about “1386029973” NPI (PENNYWELL BEHAVIORAL HEALTH CENTER) exists in 1386029973 in HTML format HTML  |  1386029973 in plain Text format TXT  |  1386029973 in PDF (Portable Document Format) PDF  |  1386029973 in an XML format XML  formats.

NPI Number : 1386029973 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386029973",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PENNYWELL BEHAVIORAL HEALTH CENTER",
    "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": "5025 NELLIS OASIS LN APT 244",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89115-0770",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "714-499-6232",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5025 NELLIS OASIS LN APT 244",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89115-0770",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-499-6232",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/23/2015",
    "LastUpdateDate": "07/23/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WASHINGTON",
    "AuthorizedOfficialFirstName": "PHILLIP",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER/PROVIDER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": "SR.",
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "714-499-6232",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251C00000X",
          "TaxonomyName": "Developmentally Disabled Services Day Training Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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