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1578960480 NPI number — CHANGES1, PLLC

NPI Number: 1578960480
Health Care Provider/Practitioner: CHANGES1, PLLC

Information about “1578960480” NPI (CHANGES1, PLLC) exists in 1578960480 in HTML format HTML  |  1578960480 in plain Text format TXT  |  1578960480 in PDF (Portable Document Format) PDF  |  1578960480 in an XML format XML  formats.

NPI Number : 1578960480 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578960480",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CHANGES1, PLLC",
    "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": "19940 CONANT",
    "SecondLineMailingAddress": "STE A, B, & C",
    "MailingAddressCityName": "DETROIT",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48234-1494",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-305-4180",
    "MailingAddressFaxNumber": "313-733-8190",
    "FirstLinePracticeLocationAddress": "19940 CONANT",
    "SecondLinePracticeLocationAddress": "STE A, B, & C",
    "PracticeLocationAddressCityName": "DETROIT",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48234-1494",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-305-4180",
    "PracticeLocationAddressFaxNumber": "313-733-8190",
    "EnumerationDate": "11/21/2014",
    "LastUpdateDate": "03/03/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TAYLOR",
    "AuthorizedOfficialFirstName": "NAOMI",
    "AuthorizedOfficialMiddleName": "DIANA",
    "AuthorizedOfficialTitle": "VICE-PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LPN",
    "AuthorizedOfficialTelephoneNumber": "313-695-3951",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM2800X",
          "TaxonomyName": "Methadone Clinic",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM2800X",
          "TaxonomyName": "Methadone Clinic",
          "LicenseNumber": "SA0823228",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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