NPI Code Detail JSON Logo

1528631561 NPI number — ANOVA HEALTHCARE SERVICES LLC

NPI Number: 1528631561
Health Care Provider/Practitioner: ANOVA HEALTHCARE SERVICES LLC

Information about “1528631561” NPI (ANOVA HEALTHCARE SERVICES LLC) exists in 1528631561 in HTML format HTML  |  1528631561 in plain Text format TXT  |  1528631561 in PDF (Portable Document Format) PDF  |  1528631561 in an XML format XML  formats.

NPI Number : 1528631561 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528631561",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ANOVA HEALTHCARE 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": "1252 S FEDERAL ST UNIT C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60605-4901",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-225-9417",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1134 E 152ND ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DOLTON",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60419-2884",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-225-9417",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/19/2021",
    "LastUpdateDate": "07/19/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SOLESI",
    "AuthorizedOfficialFirstName": "SEUN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGING PARTNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MBA",
    "AuthorizedOfficialTelephoneNumber": "773-225-9417",
    "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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