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1407508161 NPI number — BRE ENTERPRISES, LLC

NPI Number: 1407508161
Health Care Provider/Practitioner: BRE ENTERPRISES, LLC

Information about “1407508161” NPI (BRE ENTERPRISES, LLC) exists in 1407508161 in HTML format HTML  |  1407508161 in plain Text format TXT  |  1407508161 in PDF (Portable Document Format) PDF  |  1407508161 in an XML format XML  formats.

NPI Number : 1407508161 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407508161",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BRE ENTERPRISES, 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": "211 GIBSON STREET, NW",
    "SecondLineMailingAddress": "SUITE 123",
    "MailingAddressCityName": "LEESBURG",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "20176-2115",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "703-795-8793",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "211 GIBSON STREET, NW",
    "SecondLinePracticeLocationAddress": "SUITE 123",
    "PracticeLocationAddressCityName": "LEESBURG",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "20176-2115",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-561-3040",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/24/2022",
    "LastUpdateDate": "10/19/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JEFFERSON",
    "AuthorizedOfficialFirstName": "HEATHER",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR OF FINANCE",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "703-314-7846",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2083A0300X",
        "TaxonomyName": "Addiction Medicine (Preventive Medicine) Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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