NPI Code Detail JSON Logo

1710104807 NPI number — AXIS RESIDENTIAL TREATMENT LLC

NPI Number: 1710104807
Health Care Provider/Practitioner: AXIS RESIDENTIAL TREATMENT LLC

Information about “1710104807” NPI (AXIS RESIDENTIAL TREATMENT LLC) exists in 1710104807 in HTML format HTML  |  1710104807 in plain Text format TXT  |  1710104807 in PDF (Portable Document Format) PDF  |  1710104807 in an XML format XML  formats.

NPI Number : 1710104807 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710104807",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "AXIS RESIDENTIAL TREATMENT 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": "75450 FAIRWAY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIAN WELLS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92210-8421",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-469-8275",
    "MailingAddressFaxNumber": "760-346-8032",
    "FirstLinePracticeLocationAddress": "75450 FAIRWAY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIAN WELLS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92210-8421",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-469-8275",
    "PracticeLocationAddressFaxNumber": "760-346-8032",
    "EnumerationDate": "04/19/2007",
    "LastUpdateDate": "07/31/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KEITH",
    "AuthorizedOfficialFirstName": "BRAD",
    "AuthorizedOfficialMiddleName": "T",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CCDC CAD CA",
    "AuthorizedOfficialTelephoneNumber": "310-435-6298",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "324500000X",
        "TaxonomyName": "Substance Abuse Rehabilitation Facility",
        "LicenseNumber": "330082AP",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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