NPI Code Detail JSON Logo

1760381917 NPI number — FANTASTIC GARDENS ASSISTED LIVING LLC DBA FANTASTIC GARDENS HOME HEALTHCARE

NPI Number: 1760381917
Health Care Provider/Practitioner: FANTASTIC GARDENS ASSISTED LIVING LLC DBA FANTASTIC GARDENS HOME HEALTHCARE

Information about “1760381917” NPI (FANTASTIC GARDENS ASSISTED LIVING LLC DBA FANTASTIC GARDENS HOME HEALTHCARE) exists in 1760381917 in HTML format HTML  |  1760381917 in plain Text format TXT  |  1760381917 in PDF (Portable Document Format) PDF  |  1760381917 in an XML format XML  formats.

NPI Number : 1760381917 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760381917",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "FANTASTIC GARDENS ASSISTED LIVING LLC DBA FANTASTIC GARDENS HOME HEALTHCARE",
    "ParentOrgTIN": null,
    "OrgName": "FANTASTIC GARDENS ASSISTED LIVING LLC DBA FANTASTIC GARDENS HOME HEALTHCARE",
    "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": "153 BLANDING BLVD STE 4",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ORANGE PARK",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32073-2613",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-372-3736",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "153 BLANDING BLVD STE 4",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ORANGE PARK",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32073-2613",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-372-3736",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/03/2026",
    "LastUpdateDate": "11/03/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JOHNSON",
    "AuthorizedOfficialFirstName": "SHERRY",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "LPN/ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "904-554-0369",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "164W00000X",
        "TaxonomyName": "Licensed Practical Nurse",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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