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1649196965 NPI number — LEGEND WELLNESS HOME DIALYSIS

NPI Number: 1649196965
Health Care Provider/Practitioner: LEGEND WELLNESS HOME DIALYSIS

Information about “1649196965” NPI (LEGEND WELLNESS HOME DIALYSIS) exists in 1649196965 in HTML format HTML  |  1649196965 in plain Text format TXT  |  1649196965 in PDF (Portable Document Format) PDF  |  1649196965 in an XML format XML  formats.

NPI Number : 1649196965 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649196965",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "STARR PLUS PHARMACEUTICAL, INC. DBA LEGEND WELLNESS HEALTH CENTER",
    "ParentOrgTIN": null,
    "OrgName": "LEGEND WELLNESS HOME DIALYSIS",
    "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": "1919 NORTH LOOP W STE 280",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77008-1368",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "832-446-9371",
    "MailingAddressFaxNumber": "932-446-4797",
    "FirstLinePracticeLocationAddress": "1919 NORTH LOOP W STE 280",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77008-1368",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "832-446-9371",
    "PracticeLocationAddressFaxNumber": "932-446-4797",
    "EnumerationDate": "06/29/2026",
    "LastUpdateDate": "06/29/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ELEGBEDE",
    "AuthorizedOfficialFirstName": "ADETUNJI",
    "AuthorizedOfficialMiddleName": "ADESOLA",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "832-446-9371",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WH0200X",
          "TaxonomyName": "Home Health Registered Nurse",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "374U00000X",
          "TaxonomyName": "Home Health Aide",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251E00000X",
          "TaxonomyName": "Home Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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