NPI Code Detail JSON Logo

1902770308 NPI number — GRANVILLE ASSISTED LIVING - PARADISE RETREAT LLC

NPI Number: 1902770308
Health Care Provider/Practitioner: GRANVILLE ASSISTED LIVING - PARADISE RETREAT LLC

Information about “1902770308” NPI (GRANVILLE ASSISTED LIVING - PARADISE RETREAT LLC) exists in 1902770308 in HTML format HTML  |  1902770308 in plain Text format TXT  |  1902770308 in PDF (Portable Document Format) PDF  |  1902770308 in an XML format XML  formats.

NPI Number : 1902770308 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902770308",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "GRANVILLE ASSISTED LIVING - PARADISE RETREAT 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": "5420 N DOLAN CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PRESCOTT VALLEY",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "86314-6753",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "626-464-4379",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5420 N DOLAN CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PRESCOTT VALLEY",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "86314-6753",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "626-464-4379",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/30/2025",
    "LastUpdateDate": "09/30/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MARTIN",
    "AuthorizedOfficialFirstName": "GERALD",
    "AuthorizedOfficialMiddleName": "ANTHONY",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MASTER'S DEGREE",
    "AuthorizedOfficialTelephoneNumber": "626-464-4379",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "310400000X",
        "TaxonomyName": "Assisted Living Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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