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1871172536 NPI number — MILESTONE RECOVERY TRANSITIONAL LIVING

NPI Number: 1871172536
Health Care Provider/Practitioner: MILESTONE RECOVERY TRANSITIONAL LIVING

Information about “1871172536” NPI (MILESTONE RECOVERY TRANSITIONAL LIVING) exists in 1871172536 in HTML format HTML  |  1871172536 in plain Text format TXT  |  1871172536 in PDF (Portable Document Format) PDF  |  1871172536 in an XML format XML  formats.

NPI Number : 1871172536 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871172536",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "PLSN CORP.",
    "ParentOrgTIN": null,
    "OrgName": "MILESTONE RECOVERY TRANSITIONAL LIVING",
    "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": "8751 N 51ST AVE STE 108",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLENDALE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85302-4943",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-421-6667",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7340 W BETHANY HOME RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENDALE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85303-4321",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "520-329-3283",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/07/2021",
    "LastUpdateDate": "04/07/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JENKINS",
    "AuthorizedOfficialFirstName": "WELLENGTEN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MEMBER-MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "602-421-6667",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320800000X",
          "TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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