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1861079816 NPI number — SAFE HARBOR HEALTH, LLC

NPI Number: 1861079816
Health Care Provider/Practitioner: SAFE HARBOR HEALTH, LLC

Information about “1861079816” NPI (SAFE HARBOR HEALTH, LLC) exists in 1861079816 in HTML format HTML  |  1861079816 in plain Text format TXT  |  1861079816 in PDF (Portable Document Format) PDF  |  1861079816 in an XML format XML  formats.

NPI Number : 1861079816 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861079816",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SAFE HARBOR HEALTH, 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": "706 KENWOOD CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VERONA",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53593-1017",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "608-845-2081",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "706 KENWOOD CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VERONA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53593-1017",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-845-2081",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/25/2021",
    "LastUpdateDate": "03/25/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SLESAREVA",
    "AuthorizedOfficialFirstName": "JACLYN",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "OWNER, BEHAVIORAL HEALTH THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MSSW, LCSW, CSAC",
    "AuthorizedOfficialTelephoneNumber": "608-845-2081",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "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."
        },
        {
          "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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