NPI Code Detail JSON Logo

1538045562 NPI number — LANTANA WELLNESS CENTER OUTPATIENT LLC

NPI Number: 1538045562
Health Care Provider/Practitioner: LANTANA WELLNESS CENTER OUTPATIENT LLC

Information about “1538045562” NPI (LANTANA WELLNESS CENTER OUTPATIENT LLC) exists in 1538045562 in HTML format HTML  |  1538045562 in plain Text format TXT  |  1538045562 in PDF (Portable Document Format) PDF  |  1538045562 in an XML format XML  formats.

NPI Number : 1538045562 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1538045562",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LANTANA WELLNESS CENTER OUTPATIENT 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": "4009 MASONBORO LOOP RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILMINGTON",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28409-3640",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-838-9222",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "14000 S MILITARY TRL STE 112",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DELRAY BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33484-2600",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "855-544-0784",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/14/2025",
    "LastUpdateDate": "08/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BAKER",
    "AuthorizedOfficialFirstName": "CHRISTOPHER",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "704-838-9222",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "324500000X",
        "TaxonomyName": "Substance Abuse Rehabilitation Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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