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1851729982 NPI number — GREENLIFE INTENSIVE OUTPATIENT PROGRAM LLC

NPI Number: 1851729982
Health Care Provider/Practitioner: GREENLIFE INTENSIVE OUTPATIENT PROGRAM LLC

Information about “1851729982” NPI (GREENLIFE INTENSIVE OUTPATIENT PROGRAM LLC) exists in 1851729982 in HTML format HTML  |  1851729982 in plain Text format TXT  |  1851729982 in PDF (Portable Document Format) PDF  |  1851729982 in an XML format XML  formats.

NPI Number : 1851729982 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851729982",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "GREENLIFE INTENSIVE OUTPATIENT PROGRAM 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": "1601 N PALM AVE STE 106",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEMBROKE PINES",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33026-3240",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-304-6922",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1601 N PALM AVE STE 106",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PEMBROKE PINES",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33026-3240",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-854-3053",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/29/2013",
    "LastUpdateDate": "02/03/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ITZCHAKI",
    "AuthorizedOfficialFirstName": "ZVI",
    "AuthorizedOfficialMiddleName": "AHARON",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "954-304-6922",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR0405X",
          "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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