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1689687832 NPI number — SHEPHERDS LODGE INC.

NPI Number: 1689687832
Health Care Provider/Practitioner: SHEPHERDS LODGE INC.

Information about “1689687832” NPI (SHEPHERDS LODGE INC.) exists in 1689687832 in HTML format HTML  |  1689687832 in plain Text format TXT  |  1689687832 in PDF (Portable Document Format) PDF  |  1689687832 in an XML format XML  formats.

NPI Number : 1689687832 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689687832",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SHEPHERDS LODGE INC.",
    "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": "3337 KILLIAN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTSMOUTH",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23704-6024",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-393-3408",
    "MailingAddressFaxNumber": "757-397-0316",
    "FirstLinePracticeLocationAddress": "3337 KILLIAN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTSMOUTH",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23704-6024",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-393-3408",
    "PracticeLocationAddressFaxNumber": "757-397-0316",
    "EnumerationDate": "08/15/2006",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GUESS",
    "AuthorizedOfficialFirstName": "VALERIE",
    "AuthorizedOfficialMiddleName": "R",
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "B.S.",
    "AuthorizedOfficialTelephoneNumber": "757-477-5957",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "320600000X",
        "TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
        "LicenseNumber": "701",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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