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1710701149 NPI number — CAROLINA OUTPATIENT DETOX, LLC

NPI Number: 1710701149
Health Care Provider/Practitioner: CAROLINA OUTPATIENT DETOX, LLC

Information about “1710701149” NPI (CAROLINA OUTPATIENT DETOX, LLC) exists in 1710701149 in HTML format HTML  |  1710701149 in plain Text format TXT  |  1710701149 in PDF (Portable Document Format) PDF  |  1710701149 in an XML format XML  formats.

NPI Number : 1710701149 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710701149",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CAROLINA OUTPATIENT DETOX, 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": "1117 E MOREHEAD ST STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28204-2870",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1117 E MOREHEAD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLOTTE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28204-2895",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "859-304-4047",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/12/2024",
    "LastUpdateDate": "02/17/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ERB",
    "AuthorizedOfficialFirstName": "SHANNON",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "859-304-4047",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QR0405X",
        "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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