NPI Code Detail JSON Logo

1891824892 NPI number — AUTUMN LEAVES, INC.

NPI Number: 1891824892
Health Care Provider/Practitioner: AUTUMN LEAVES, INC.

Information about “1891824892” NPI (AUTUMN LEAVES, INC.) exists in 1891824892 in HTML format HTML  |  1891824892 in plain Text format TXT  |  1891824892 in PDF (Portable Document Format) PDF  |  1891824892 in an XML format XML  formats.

NPI Number : 1891824892 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891824892",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "AUTUMN LEAVES. INC",
    "ParentOrgTIN": null,
    "OrgName": "AUTUMN LEAVES, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2576 N GREENWAY RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CERRO GORDO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "61818-3022",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-763-2191",
    "MailingAddressFaxNumber": "217-763-2101",
    "FirstLinePracticeLocationAddress": "3905 E. HICKORY ST.",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DECATUR",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62521",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-429-8231",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/05/2007",
    "LastUpdateDate": "01/23/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JACOBUS",
    "AuthorizedOfficialFirstName": "DAVID",
    "AuthorizedOfficialMiddleName": "MICHAEL",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "217-763-2191",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "315P00000X",
        "TaxonomyName": "Intellectual Disabilities Intermediate Care Facility",
        "LicenseNumber": "37846",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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