NPI Code Detail JSON Logo

1760621007 NPI number — SHADOW MOUNTAIN LLC.

NPI Number: 1760621007
Health Care Provider/Practitioner: SHADOW MOUNTAIN LLC.

Information about “1760621007” NPI (SHADOW MOUNTAIN LLC.) exists in 1760621007 in HTML format HTML  |  1760621007 in plain Text format TXT  |  1760621007 in PDF (Portable Document Format) PDF  |  1760621007 in an XML format XML  formats.

NPI Number : 1760621007 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760621007",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SHADOW MOUNTAIN LLC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5400 GIBSON BLVD. S.E",
    "SecondLineMailingAddress": "3RD FLOOR",
    "MailingAddressCityName": "ALBUQUERQUE",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87109",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-867-0214",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5400 GIBSON BLVD. S. E",
    "SecondLinePracticeLocationAddress": "3RD FLOOR",
    "PracticeLocationAddressCityName": "ALBUQUERQUE",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87109",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-296-8184",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/10/2009",
    "LastUpdateDate": "10/28/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HOLUB",
    "AuthorizedOfficialFirstName": "JACKIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGING DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "925-389-8591",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "324500000X",
        "TaxonomyName": "Substance Abuse Rehabilitation Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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