NPI Code Detail JSON Logo

1487318671 NPI number — 1DERFULL MINDS, INC.

NPI Number: 1487318671
Health Care Provider/Practitioner: 1DERFULL MINDS, INC.

Information about “1487318671” NPI (1DERFULL MINDS, INC.) exists in 1487318671 in HTML format HTML  |  1487318671 in plain Text format TXT  |  1487318671 in PDF (Portable Document Format) PDF  |  1487318671 in an XML format XML  formats.

NPI Number : 1487318671 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487318671",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "1DERFULL MINDS, INC.",
    "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": "631 CRESENT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DESOTO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75115-8017",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "469-235-2390",
    "MailingAddressFaxNumber": "972-637-7576",
    "FirstLinePracticeLocationAddress": "631 CRESENT DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DESOTO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75115-8017",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "469-235-2390",
    "PracticeLocationAddressFaxNumber": "972-637-7576",
    "EnumerationDate": "10/25/2021",
    "LastUpdateDate": "09/29/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MILES",
    "AuthorizedOfficialFirstName": "ELLA",
    "AuthorizedOfficialMiddleName": "MARIE",
    "AuthorizedOfficialTitle": "PRESIDENT/PROGRAM MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "BBA, LVN",
    "AuthorizedOfficialTelephoneNumber": "469-235-2390",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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