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1669887352 NPI number — DIVERSICARE OF RIVERSIDE, LLC

NPI Number: 1669887352
Health Care Provider/Practitioner: DIVERSICARE OF RIVERSIDE, LLC

Information about “1669887352” NPI (DIVERSICARE OF RIVERSIDE, LLC) exists in 1669887352 in HTML format HTML  |  1669887352 in plain Text format TXT  |  1669887352 in PDF (Portable Document Format) PDF  |  1669887352 in an XML format XML  formats.

NPI Number : 1669887352 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669887352",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "DIVERSICARE LEASING COMPANY II, LLC",
    "ParentOrgTIN": null,
    "OrgName": "DIVERSICARE OF RIVERSIDE, LLC",
    "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": "1616 WEISENBORN RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT JOSEPH",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "64507-2527",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "816-232-9874",
    "MailingAddressFaxNumber": "816-364-4283",
    "FirstLinePracticeLocationAddress": "1616 WEISENBORN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT JOSEPH",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "64507-2527",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "816-232-9874",
    "PracticeLocationAddressFaxNumber": "816-364-4283",
    "EnumerationDate": "06/22/2014",
    "LastUpdateDate": "04/07/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WEISHAAR",
    "AuthorizedOfficialFirstName": "MATTHEW",
    "AuthorizedOfficialMiddleName": "J",
    "AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "615-771-7575",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "310400000X",
          "TaxonomyName": "Assisted Living Facility",
          "LicenseNumber": "042402",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "314000000X",
          "TaxonomyName": "Skilled Nursing Facility",
          "LicenseNumber": "042401",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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