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1740687664 NPI number — PHOENIX CM INC.

NPI Number: 1740687664
Health Care Provider/Practitioner: PHOENIX CM INC.

Information about “1740687664” NPI (PHOENIX CM INC.) exists in 1740687664 in HTML format HTML  |  1740687664 in plain Text format TXT  |  1740687664 in PDF (Portable Document Format) PDF  |  1740687664 in an XML format XML  formats.

NPI Number : 1740687664 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740687664",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PHOENIX CM INC.",
    "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": "52 TUSCAN WAY STE 202-142",
    "SecondLineMailingAddress": "STE. 202-142",
    "MailingAddressCityName": "SAINT AUGUSTINE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32092-1850",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-377-6735",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1225 W BEAVER ST STE 101",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32204-1415",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-377-6735",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/20/2014",
    "LastUpdateDate": "11/20/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RUSSELL",
    "AuthorizedOfficialFirstName": "ELLA",
    "AuthorizedOfficialMiddleName": "B",
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "904-377-6735",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251B00000X",
        "TaxonomyName": "Case Management Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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