NPI Code Detail JSON Logo

1952837809 NPI number — GRAPEVINE CLINICAL LLC

NPI Number: 1952837809
Health Care Provider/Practitioner: GRAPEVINE CLINICAL LLC

Information about “1952837809” NPI (GRAPEVINE CLINICAL LLC) exists in 1952837809 in HTML format HTML  |  1952837809 in plain Text format TXT  |  1952837809 in PDF (Portable Document Format) PDF  |  1952837809 in an XML format XML  formats.

NPI Number : 1952837809 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952837809",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "GRAPEVINE CLINICAL 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": "4949 PLEASANT ST STE 104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST DES MOINES",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "50266-5494",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "515-369-0034",
    "MailingAddressFaxNumber": "844-381-0919",
    "FirstLinePracticeLocationAddress": "666 WALNUT ST STE 1610",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DES MOINES",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "50309-3974",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "515-360-0034",
    "PracticeLocationAddressFaxNumber": "844-381-0919",
    "EnumerationDate": "05/11/2017",
    "LastUpdateDate": "02/06/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TILLGREN",
    "AuthorizedOfficialFirstName": "WENDY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PARTNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "515-421-9915",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "007572",
        "LicenseNumberStateCode": "IA",
        "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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