NPI Code Detail JSON Logo

1942609771 NPI number — PENNACLE FOUNDATION, INC.

NPI Number: 1942609771
Health Care Provider/Practitioner: PENNACLE FOUNDATION, INC.

Information about “1942609771” NPI (PENNACLE FOUNDATION, INC.) exists in 1942609771 in HTML format HTML  |  1942609771 in plain Text format TXT  |  1942609771 in PDF (Portable Document Format) PDF  |  1942609771 in an XML format XML  formats.

NPI Number : 1942609771 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942609771",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PENNACLE FOUNDATION, INC.",
    "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": "PO BOX 18224",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90018-0224",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "323-750-2400",
    "MailingAddressFaxNumber": "323-825-5660",
    "FirstLinePracticeLocationAddress": "5125 CRENSHAW BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90043-1853",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "323-750-2400",
    "PracticeLocationAddressFaxNumber": "323-825-5660",
    "EnumerationDate": "08/18/2014",
    "LastUpdateDate": "08/18/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RUFFIN",
    "AuthorizedOfficialFirstName": "CAROLYN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "323-750-2400",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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