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1497497234 NPI number — RIVER REGION HUMAN SERVICES RESIDENTIAL

NPI Number: 1497497234
Health Care Provider/Practitioner: RIVER REGION HUMAN SERVICES RESIDENTIAL

Information about “1497497234” NPI (RIVER REGION HUMAN SERVICES RESIDENTIAL) exists in 1497497234 in HTML format HTML  |  1497497234 in plain Text format TXT  |  1497497234 in PDF (Portable Document Format) PDF  |  1497497234 in an XML format XML  formats.

NPI Number : 1497497234 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497497234",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "RIVER REGION HUMAN SERVICES INC",
    "ParentOrgTIN": null,
    "OrgName": "RIVER REGION HUMAN SERVICES RESIDENTIAL",
    "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": "3901 CARMICHAEL AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32207-2325",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-899-6300",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2981 PARENTAL HOME RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32216-5797",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-899-6300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/12/2022",
    "LastUpdateDate": "04/12/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DISTEFANO",
    "AuthorizedOfficialFirstName": "JOHN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CONSULTANT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "352-317-3214",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "320800000X",
        "TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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