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1457177370 NPI number — JERAN HEALTH CARE SERVICES, LLC

NPI Number: 1457177370
Health Care Provider/Practitioner: JERAN HEALTH CARE SERVICES, LLC

Information about “1457177370” NPI (JERAN HEALTH CARE SERVICES, LLC) exists in 1457177370 in HTML format HTML  |  1457177370 in plain Text format TXT  |  1457177370 in PDF (Portable Document Format) PDF  |  1457177370 in an XML format XML  formats.

NPI Number : 1457177370 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457177370",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "JERAN HEALTH CARE 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": "605 CARTWELL DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STAFFORD",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22554-7374",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "571-438-3133",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "605 CARTWELL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STAFFORD",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22554-7374",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-438-3133",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/25/2024",
    "LastUpdateDate": "11/25/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BOLANDER",
    "AuthorizedOfficialFirstName": "JURRIAAN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "571-438-3133",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "320900000X",
        "TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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