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1679396352 NPI number — COLTIN CARE HOMES LLC

NPI Number: 1679396352
Health Care Provider/Practitioner: COLTIN CARE HOMES LLC

Information about “1679396352” NPI (COLTIN CARE HOMES LLC) exists in 1679396352 in HTML format HTML  |  1679396352 in plain Text format TXT  |  1679396352 in PDF (Portable Document Format) PDF  |  1679396352 in an XML format XML  formats.

NPI Number : 1679396352 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679396352",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "COLTIN CARE HOMES 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": "1616 N ENCINA AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIALTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92376-2911",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1616 N ENCINA AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIALTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92376-2911",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "818-307-3675",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/01/2024",
    "LastUpdateDate": "11/01/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ZARGARYAN",
    "AuthorizedOfficialFirstName": "DAVIT",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "818-307-3675",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "313M00000X",
          "TaxonomyName": "Nursing Facility/Intermediate Care Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "315P00000X",
          "TaxonomyName": "Intellectual Disabilities Intermediate Care Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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