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1730711219 NPI number — NORTH FLORIDA SENIOR LIVING LLC

NPI Number: 1730711219
Health Care Provider/Practitioner: NORTH FLORIDA SENIOR LIVING LLC

Information about “1730711219” NPI (NORTH FLORIDA SENIOR LIVING LLC) exists in 1730711219 in HTML format HTML  |  1730711219 in plain Text format TXT  |  1730711219 in PDF (Portable Document Format) PDF  |  1730711219 in an XML format XML  formats.

NPI Number : 1730711219 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730711219",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NORTH FLORIDA SENIOR LIVING 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": "614 BOWLES CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEPTUNE BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32266-3602",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-635-6081",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "541103 LEM TURNER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CALLAHAN",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32011-8546",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-635-6081",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/12/2020",
    "LastUpdateDate": "02/06/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CHERNYAK",
    "AuthorizedOfficialFirstName": "EVGENY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "VICE PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "904-635-6081",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3104A0630X",
        "TaxonomyName": "Assisted Living Facility (Behavioral Disturbances)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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