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1891200317 NPI number — ADVANCED CLINICAL HEALTH SERVICE CORPORATION

NPI Number: 1891200317
Health Care Provider/Practitioner: ADVANCED CLINICAL HEALTH SERVICE CORPORATION

Information about “1891200317” NPI (ADVANCED CLINICAL HEALTH SERVICE CORPORATION) exists in 1891200317 in HTML format HTML  |  1891200317 in plain Text format TXT  |  1891200317 in PDF (Portable Document Format) PDF  |  1891200317 in an XML format XML  formats.

NPI Number : 1891200317 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891200317",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ADVANCED CLINICAL HEALTH SERVICE CORPORATION",
    "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": "2925 S WABASH AVE STE 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60616-3583",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-879-2274",
    "MailingAddressFaxNumber": "312-225-6742",
    "FirstLinePracticeLocationAddress": "2925 S WABASH AVE STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60616-3583",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-879-2274",
    "PracticeLocationAddressFaxNumber": "312-225-6742",
    "EnumerationDate": "12/06/2017",
    "LastUpdateDate": "12/06/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DAVIS",
    "AuthorizedOfficialFirstName": "EDRENA",
    "AuthorizedOfficialMiddleName": "JOY",
    "AuthorizedOfficialTitle": "LICENSED CLINICAL SOCIAL WORKER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW",
    "AuthorizedOfficialTelephoneNumber": "773-879-2274",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "149018258",
        "LicenseNumberStateCode": "IL",
        "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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