NPI Code Detail JSON Logo

1669143467 NPI number — SUCCESSFUL MINDS LLC

NPI Number: 1669143467
Health Care Provider/Practitioner: SUCCESSFUL MINDS LLC

Information about “1669143467” NPI (SUCCESSFUL MINDS LLC) exists in 1669143467 in HTML format HTML  |  1669143467 in plain Text format TXT  |  1669143467 in PDF (Portable Document Format) PDF  |  1669143467 in an XML format XML  formats.

NPI Number : 1669143467 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669143467",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SUCCESSFUL MINDS 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": "2134 -2 CAPERNIUM RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHERRYVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28021-9478",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-418-7257",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2134 -2 CAPERNIUM RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHERRYVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28021-9478",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-418-7257",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/22/2021",
    "LastUpdateDate": "09/22/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BURSTON",
    "AuthorizedOfficialFirstName": "ANNETTE",
    "AuthorizedOfficialMiddleName": "WILLIAMS",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "704-284-8784",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "252Y00000X",
        "TaxonomyName": "Early Intervention Provider Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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