NPI Code Detail JSON Logo

1851085765 NPI number — 360 SUPPORTS LLC

NPI Number: 1851085765
Health Care Provider/Practitioner: 360 SUPPORTS LLC

Information about “1851085765” NPI (360 SUPPORTS LLC) exists in 1851085765 in HTML format HTML  |  1851085765 in plain Text format TXT  |  1851085765 in PDF (Portable Document Format) PDF  |  1851085765 in an XML format XML  formats.

NPI Number : 1851085765 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851085765",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "360 SUPPORTS 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": "768 ESTATES DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CAMDEN WYOMING",
    "MailingAddressStateName": "DE",
    "MailingAddressPostalCode": "19934-4611",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "703-509-8778",
    "MailingAddressFaxNumber": "202-240-3090",
    "FirstLinePracticeLocationAddress": "6911 RICHMOND HWY STE 245",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALEXANDRIA",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22306-1844",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-509-8778",
    "PracticeLocationAddressFaxNumber": "202-240-3090",
    "EnumerationDate": "06/05/2023",
    "LastUpdateDate": "06/05/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GOMIA",
    "AuthorizedOfficialFirstName": "VICTOR",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PROGRAM DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "703-509-8778",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251C00000X",
        "TaxonomyName": "Developmentally Disabled Services Day Training Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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