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1790210169 NPI number — SAFE HARBOR BEHAVIORAL HEALTH LLC

NPI Number: 1790210169
Health Care Provider/Practitioner: SAFE HARBOR BEHAVIORAL HEALTH LLC

Information about “1790210169” NPI (SAFE HARBOR BEHAVIORAL HEALTH LLC) exists in 1790210169 in HTML format HTML  |  1790210169 in plain Text format TXT  |  1790210169 in PDF (Portable Document Format) PDF  |  1790210169 in an XML format XML  formats.

NPI Number : 1790210169 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790210169",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SAFE HARBOR BEHAVIORAL HEALTH 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": "302A MIDLAND PKWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SUMMERVILLE",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29485-8102",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": "509-479-4389",
    "FirstLinePracticeLocationAddress": "302A MIDLAND PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SUMMERVILLE",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29485-8102",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-469-0935",
    "PracticeLocationAddressFaxNumber": "509-479-4389",
    "EnumerationDate": "04/24/2017",
    "LastUpdateDate": "04/24/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "REDDOUT",
    "AuthorizedOfficialFirstName": "KIMBERLY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER, COUNSELOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MA, LPC",
    "AuthorizedOfficialTelephoneNumber": "843-469-0935",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": "6274",
        "LicenseNumberStateCode": "SC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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