NPI Code Detail JSON Logo

1568017374 NPI number — THE BRIDGE AUTISM CLINIC LLC

NPI Number: 1568017374
Health Care Provider/Practitioner: THE BRIDGE AUTISM CLINIC LLC

Information about “1568017374” NPI (THE BRIDGE AUTISM CLINIC LLC) exists in 1568017374 in HTML format HTML  |  1568017374 in plain Text format TXT  |  1568017374 in PDF (Portable Document Format) PDF  |  1568017374 in an XML format XML  formats.

NPI Number : 1568017374 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568017374",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "THE BRIDGE AUTISM CLINIC LLC",
    "ParentOrgTIN": null,
    "OrgName": "THE BRIDGE AUTISM CLINIC 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": "690 CLEVELAND AVE S # 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT PAUL",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55116-1319",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "690 CLEVELAND AVE SOUTH",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "ST PAUL",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55116",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "612-216-4647",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/08/2019",
    "LastUpdateDate": "12/10/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HAMILTON",
    "AuthorizedOfficialFirstName": "MELISSA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "651-493-8412",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0855X",
        "TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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