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1730707175 NPI number — BERNADETTE PREMIUM HEALTHCARE LLC

NPI Number: 1730707175
Health Care Provider/Practitioner: BERNADETTE PREMIUM HEALTHCARE LLC

Information about “1730707175” NPI (BERNADETTE PREMIUM HEALTHCARE LLC) exists in 1730707175 in HTML format HTML  |  1730707175 in plain Text format TXT  |  1730707175 in PDF (Portable Document Format) PDF  |  1730707175 in an XML format XML  formats.

NPI Number : 1730707175 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730707175",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BERNADETTE PREMIUM HEALTHCARE 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": "2546 CANTERBURY DR N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIVIERA BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33407-1316",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "561-502-9416",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2546 CANTERBURY DR N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIVIERA BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33407-1316",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-502-9416",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/13/2020",
    "LastUpdateDate": "07/13/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DATIS",
    "AuthorizedOfficialFirstName": "MARIE VERONIQUE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "561-502-9416",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QD1600X",
        "TaxonomyName": "Developmental Disabilities Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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