NPI Code Detail JSON Logo

1700134046 NPI number — RUSS RECOVERY IOP SERVCES- PC

NPI Number: 1700134046
Health Care Provider/Practitioner: RUSS RECOVERY IOP SERVCES- PC

Information about “1700134046” NPI (RUSS RECOVERY IOP SERVCES- PC) exists in 1700134046 in HTML format HTML  |  1700134046 in plain Text format TXT  |  1700134046 in PDF (Portable Document Format) PDF  |  1700134046 in an XML format XML  formats.

NPI Number : 1700134046 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700134046",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RUSS RECOVERY IOP SERVCES- PC",
    "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": "2825 TAHQUITZ CANYON WAY",
    "SecondLineMailingAddress": "BLDG C",
    "MailingAddressCityName": "PALM SPRINGS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92262-7038",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "866-484-6444",
    "MailingAddressFaxNumber": "760-416-7709",
    "FirstLinePracticeLocationAddress": "2825 TAHQUITZ CANYON WAY",
    "SecondLinePracticeLocationAddress": "BLDG C",
    "PracticeLocationAddressCityName": "PALM SPRINGS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92262",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "866-484-6444",
    "PracticeLocationAddressFaxNumber": "760-416-7709",
    "EnumerationDate": "08/16/2012",
    "LastUpdateDate": "07/02/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RUSS",
    "AuthorizedOfficialFirstName": "KENNETH",
    "AuthorizedOfficialMiddleName": "CARL",
    "AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "760-416-7755",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QR0401X",
          "TaxonomyName": "Comprehensive Outpatient Rehabilitation Facility (CORF)",
          "LicenseNumber": "MFC49984",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "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."
      }
    }
  }
}
                
            

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