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1962379933 NPI number — NBH JACKSON ST LLC

NPI Number: 1962379933
Health Care Provider/Practitioner: NBH JACKSON ST LLC

Information about “1962379933” NPI (NBH JACKSON ST LLC) exists in 1962379933 in HTML format HTML  |  1962379933 in plain Text format TXT  |  1962379933 in PDF (Portable Document Format) PDF  |  1962379933 in an XML format XML  formats.

NPI Number : 1962379933 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962379933",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NBH JACKSON ST 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": "2345 ARIEL ST N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MAPLEWOOD",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55109-2248",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1609 JACKSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT PAUL",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55117-3917",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-487-4987",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/22/2025",
    "LastUpdateDate": "10/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WELDLER",
    "AuthorizedOfficialFirstName": "MARK",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "773-919-9351",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "324500000X",
        "TaxonomyName": "Substance Abuse Rehabilitation Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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