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1811513765 NPI number — BEAUTIFUL GRACE, LLC

NPI Number: 1811513765
Health Care Provider/Practitioner: BEAUTIFUL GRACE, LLC

Information about “1811513765” NPI (BEAUTIFUL GRACE, LLC) exists in 1811513765 in HTML format HTML  |  1811513765 in plain Text format TXT  |  1811513765 in PDF (Portable Document Format) PDF  |  1811513765 in an XML format XML  formats.

NPI Number : 1811513765 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811513765",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BEAUTIFUL GRACE, 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": "100 HANDY HILL RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MER ROUGE",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "71261-6900",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "318-239-1312",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 HANDY HILL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MER ROUGE",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "71261-6900",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "318-239-1312",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/17/2020",
    "LastUpdateDate": "06/17/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SYLVESTER",
    "AuthorizedOfficialFirstName": "SHANTEAU",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CRANIAL PROSTHESIS SPECIALIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "318-239-1312",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM2500X",
          "TaxonomyName": "Medical Specialty Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332BC3200X",
          "TaxonomyName": "Customized Equipment (DME)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "335E00000X",
          "TaxonomyName": "Prosthetic/Orthotic Supplier",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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