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1407482268 NPI number — LOLOMA HOUSES LLC

NPI Number: 1407482268
Health Care Provider/Practitioner: LOLOMA HOUSES LLC

Information about “1407482268” NPI (LOLOMA HOUSES LLC) exists in 1407482268 in HTML format HTML  |  1407482268 in plain Text format TXT  |  1407482268 in PDF (Portable Document Format) PDF  |  1407482268 in an XML format XML  formats.

NPI Number : 1407482268 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407482268",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "LOLOMA HOUSE LLC",
    "ParentOrgTIN": null,
    "OrgName": "LOLOMA HOUSES 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": "8408 W WILLOW AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEORIA",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85381-4864",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "623-418-6657",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6125 W SUNNYSIDE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENDALE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85304-2533",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "623-418-6657",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/12/2020",
    "LastUpdateDate": "03/27/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HORNBACK",
    "AuthorizedOfficialFirstName": "LAURA",
    "AuthorizedOfficialMiddleName": "ADILOBA",
    "AuthorizedOfficialTitle": "OWNER / ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "623-418-6657",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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