NPI Code Detail JSON Logo

1811712987 NPI number — BEVERELY PLACE LLC

NPI Number: 1811712987
Health Care Provider/Practitioner: BEVERELY PLACE LLC

Information about “1811712987” NPI (BEVERELY PLACE LLC) exists in 1811712987 in HTML format HTML  |  1811712987 in plain Text format TXT  |  1811712987 in PDF (Portable Document Format) PDF  |  1811712987 in an XML format XML  formats.

NPI Number : 1811712987 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811712987",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BEVERELY PLACE 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": "5763 DE BACA CT NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIO RANCHO",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87144-5213",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-395-8682",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5763 DE BACA CT NE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIO RANCHO",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87144-5213",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "609-457-4506",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/22/2024",
    "LastUpdateDate": "12/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BROWNELL",
    "AuthorizedOfficialFirstName": "BAZE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RN",
    "AuthorizedOfficialTelephoneNumber": "877-963-2123",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "315P00000X",
        "TaxonomyName": "Intellectual Disabilities Intermediate Care Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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