NPI Code Detail JSON Logo

1619090628 NPI number — CONSUMER CARE LLC

NPI Number: 1619090628
Health Care Provider/Practitioner: CONSUMER CARE LLC

Information about “1619090628” NPI (CONSUMER CARE LLC) exists in 1619090628 in HTML format HTML  |  1619090628 in plain Text format TXT  |  1619090628 in PDF (Portable Document Format) PDF  |  1619090628 in an XML format XML  formats.

NPI Number : 1619090628 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619090628",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CONSUMER CARE 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": "645 W CLARK ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POCATELLO",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83204-3141",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-234-9361",
    "MailingAddressFaxNumber": "208-236-1855",
    "FirstLinePracticeLocationAddress": "645 W CLARK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "POCATELLO",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83204-3141",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-234-9361",
    "PracticeLocationAddressFaxNumber": "208-909-2662",
    "EnumerationDate": "04/06/2007",
    "LastUpdateDate": "07/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RASMUSSEN",
    "AuthorizedOfficialFirstName": "HEIDI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CLINICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW, CADC",
    "AuthorizedOfficialTelephoneNumber": "208-226-4637",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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