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1538932140 NPI number — FAYETTE BHC LLC

NPI Number: 1538932140
Health Care Provider/Practitioner: FAYETTE BHC LLC

Information about “1538932140” NPI (FAYETTE BHC LLC) exists in 1538932140 in HTML format HTML  |  1538932140 in plain Text format TXT  |  1538932140 in PDF (Portable Document Format) PDF  |  1538932140 in an XML format XML  formats.

NPI Number : 1538932140 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1538932140",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FAYETTE BHC 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": "450 ERIE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CONNERSVILLE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47331-3176",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "450 ERIE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CONNERSVILLE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47331-3176",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "765-827-8022",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/06/2023",
    "LastUpdateDate": "03/20/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "COSTLEY",
    "AuthorizedOfficialFirstName": "JESSIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR OF PROVIDER ENROLLMENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "443-839-6928",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QR0405X",
          "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "324500000X",
          "TaxonomyName": "Substance Abuse Rehabilitation Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3245S0500X",
          "TaxonomyName": "Children's Substance Abuse Rehabilitation Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "323P00000X",
          "TaxonomyName": "Psychiatric Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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