NPI Code Detail JSON Logo

1699620773 NPI number — VINCULUM CARE FOUNDATION

NPI Number: 1699620773
Health Care Provider/Practitioner: VINCULUM CARE FOUNDATION

Information about “1699620773” NPI (VINCULUM CARE FOUNDATION) exists in 1699620773 in HTML format HTML  |  1699620773 in plain Text format TXT  |  1699620773 in PDF (Portable Document Format) PDF  |  1699620773 in an XML format XML  formats.

NPI Number : 1699620773 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699620773",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "VINCULUM CARE FOUNDATION",
    "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": "1530 PINE GROVE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORT HURON",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48060-3370",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "810-357-8792",
    "MailingAddressFaxNumber": "810-512-7725",
    "FirstLinePracticeLocationAddress": "1530 PINE GROVE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORT HURON",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48060-3370",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "810-357-8792",
    "PracticeLocationAddressFaxNumber": "810-512-7725",
    "EnumerationDate": "03/03/2026",
    "LastUpdateDate": "03/03/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HUSSAIN",
    "AuthorizedOfficialFirstName": "ELIA",
    "AuthorizedOfficialMiddleName": "EJAZ",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "810-357-8792",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WC0400X",
          "TaxonomyName": "Case Management Registered Nurse",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QA0600X",
          "TaxonomyName": "Adult Day Care Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR1300X",
          "TaxonomyName": "Rural Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "385H00000X",
          "TaxonomyName": "Respite Care",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251E00000X",
          "TaxonomyName": "Home Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251J00000X",
          "TaxonomyName": "Nursing Care Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "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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