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1699516401 NPI number — VITALITY COMMUNITY CARE CENTER

NPI Number: 1699516401
Health Care Provider/Practitioner: VITALITY COMMUNITY CARE CENTER

Information about “1699516401” NPI (VITALITY COMMUNITY CARE CENTER) exists in 1699516401 in HTML format HTML  |  1699516401 in plain Text format TXT  |  1699516401 in PDF (Portable Document Format) PDF  |  1699516401 in an XML format XML  formats.

NPI Number : 1699516401 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699516401",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "VITALITY COMMUNITY CARE CENTER",
    "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": "1391 W 5TH AVE # 241",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBUS",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "43212-2902",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "614-664-3331",
    "MailingAddressFaxNumber": "888-831-0965",
    "FirstLinePracticeLocationAddress": "2686 CROSSROADS PLAZA DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBUS",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "43219-3442",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "614-664-3331",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/05/2024",
    "LastUpdateDate": "06/05/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CARROLL",
    "AuthorizedOfficialFirstName": "LATONYA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DNP",
    "AuthorizedOfficialTelephoneNumber": "614-644-3331",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084A0401X",
          "TaxonomyName": "Addiction Medicine (Psychiatry & Neurology) Physician",
          "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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