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1790994796 NPI number — CAPITOL CITY RESIDENTIAL HEALTH CARE LLC

NPI Number: 1790994796
Health Care Provider/Practitioner: CAPITOL CITY RESIDENTIAL HEALTH CARE LLC

Information about “1790994796” NPI (CAPITOL CITY RESIDENTIAL HEALTH CARE LLC) exists in 1790994796 in HTML format HTML  |  1790994796 in plain Text format TXT  |  1790994796 in PDF (Portable Document Format) PDF  |  1790994796 in an XML format XML  formats.

NPI Number : 1790994796 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790994796",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CAPITOL CITY RESIDENTIAL HEALTH CARE 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": "1608 E 10TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIANAPOLIS",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46201-1902",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "317-632-1851",
    "MailingAddressFaxNumber": "866-480-7748",
    "FirstLinePracticeLocationAddress": "1608 E 10TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIANAPOLIS",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46201-1902",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-632-1851",
    "PracticeLocationAddressFaxNumber": "866-480-7748",
    "EnumerationDate": "05/22/2007",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DERICO",
    "AuthorizedOfficialFirstName": "KELLEE",
    "AuthorizedOfficialMiddleName": "R.",
    "AuthorizedOfficialTitle": "ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "317-632-1851",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3104A0625X",
        "TaxonomyName": "Assisted Living Facility (Mental Illness)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "IN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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