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1568197556 NPI number — REVIVE 180 LLC

NPI Number: 1568197556
Health Care Provider/Practitioner: REVIVE 180 LLC

Information about “1568197556” NPI (REVIVE 180 LLC) exists in 1568197556 in HTML format HTML  |  1568197556 in plain Text format TXT  |  1568197556 in PDF (Portable Document Format) PDF  |  1568197556 in an XML format XML  formats.

NPI Number : 1568197556 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568197556",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "REVIVE 180 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": "10071 CRESCENT RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POTOSI",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63664-2040",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "573-438-9800",
    "MailingAddressFaxNumber": "573-240-9916",
    "FirstLinePracticeLocationAddress": "10071 CRESCENT RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "POTOSI",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63664-2040",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-438-9800",
    "PracticeLocationAddressFaxNumber": "573-240-9916",
    "EnumerationDate": "07/22/2022",
    "LastUpdateDate": "12/11/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PASHIA",
    "AuthorizedOfficialFirstName": "CHRISTY",
    "AuthorizedOfficialMiddleName": "L",
    "AuthorizedOfficialTitle": "PROFESSIONAL COUNSELOR/OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LPC",
    "AuthorizedOfficialTelephoneNumber": "573-438-9800",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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