NPI Code Detail JSON Logo

1407721772 NPI number — DIVINE MEDICAL STAFFING SERVICES LLC

NPI Number: 1407721772
Health Care Provider/Practitioner: DIVINE MEDICAL STAFFING SERVICES LLC

Information about “1407721772” NPI (DIVINE MEDICAL STAFFING SERVICES LLC) exists in 1407721772 in HTML format HTML  |  1407721772 in plain Text format TXT  |  1407721772 in PDF (Portable Document Format) PDF  |  1407721772 in an XML format XML  formats.

NPI Number : 1407721772 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407721772",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DIVINE MEDICAL STAFFING SERVICES 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": "22322 RIO ALTO DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COTTONWOOD",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "96022-7928",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "530-710-3897",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "22322 RIO ALTO DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COTTONWOOD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "96022-7928",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "530-710-3897",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/07/2025",
    "LastUpdateDate": "10/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RICARDO",
    "AuthorizedOfficialFirstName": "ALYSSA",
    "AuthorizedOfficialMiddleName": "NICHELLE",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "530-710-3897",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251E00000X",
          "TaxonomyName": "Home Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251J00000X",
          "TaxonomyName": "Nursing Care Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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