1568803146 NPI number — THE MOBILE TOOTH FAIRY P.S.

NPI Number: 1568803146
Health Care Provider/Practitioner: THE MOBILE TOOTH FAIRY P.S.

NPI Number : 1568803146 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568803146",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE MOBILE TOOTH FAIRY P.S.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6610 89TH STREET CT E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PUYALLUP",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98371-6222",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-444-7112",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6610 89TH STREET CT E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PUYALLUP",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98371-6222",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-444-7112",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/11/2013",
    "LastUpdateDate": "07/11/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FINK",
    "AuthorizedOfficialFirstName": "NICOLE",
    "AuthorizedOfficialMiddleName": "LEE",
    "AuthorizedOfficialTitle": "PRESIDENT/OWNER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RDH",
    "AuthorizedOfficialTelephoneNumber": "253-444-7112",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QA0600X",
          "TaxonomyName": "Adult Day Care Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QC1500X",
          "TaxonomyName": "Community Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QD0000X",
          "TaxonomyName": "Dental Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0801X",
          "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP0905X",
          "TaxonomyName": "State or Local Public Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QV0200X",
          "TaxonomyName": "VA Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3104A0625X",
          "TaxonomyName": "Assisted Living Facility (Mental Illness)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3104A0630X",
          "TaxonomyName": "Assisted Living Facility (Behavioral Disturbances)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "310500000X",
          "TaxonomyName": "Mental Illness Intermediate Care Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "311500000X",
          "TaxonomyName": "Alzheimer Center (Dementia Center)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "311ZA0620X",
          "TaxonomyName": "Adult Care Home Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "313M00000X",
          "TaxonomyName": "Nursing Facility/Intermediate Care Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "314000000X",
          "TaxonomyName": "Skilled Nursing Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "315P00000X",
          "TaxonomyName": "Intellectual Disabilities Intermediate Care Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "310400000X",
          "TaxonomyName": "Assisted Living Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}