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1740407493 NPI number — PEACHTREE LANE AT MENA, LLC

NPI Number: 1740407493
Health Care Provider/Practitioner: PEACHTREE LANE AT MENA, LLC

Information about “1740407493” NPI (PEACHTREE LANE AT MENA, LLC) exists in 1740407493 in HTML format HTML  |  1740407493 in plain Text format TXT  |  1740407493 in PDF (Portable Document Format) PDF  |  1740407493 in an XML format XML  formats.

NPI Number : 1740407493 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740407493",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PEACHTREE LANE AT MENA, 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": "1422 FRESNO ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT SMITH",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72901-7065",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "479-783-0718",
    "MailingAddressFaxNumber": "479-783-8564",
    "FirstLinePracticeLocationAddress": "1803 CORDIE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MENA",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "71953-9340",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-394-2600",
    "PracticeLocationAddressFaxNumber": "479-394-2608",
    "EnumerationDate": "04/20/2007",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LANDRUM",
    "AuthorizedOfficialFirstName": "ANNETTE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGING MEMBER OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "479-783-0718",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "310400000X",
        "TaxonomyName": "Assisted Living Facility",
        "LicenseNumber": "008",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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