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1962781971 NPI number — PROVISO LEYDEN COUNCIL FOR COMMUNITY ACTION

NPI Number: 1962781971
Health Care Provider/Practitioner: PROVISO LEYDEN COUNCIL FOR COMMUNITY ACTION

Information about “1962781971” NPI (PROVISO LEYDEN COUNCIL FOR COMMUNITY ACTION) exists in 1962781971 in HTML format HTML  |  1962781971 in plain Text format TXT  |  1962781971 in PDF (Portable Document Format) PDF  |  1962781971 in an XML format XML  formats.

NPI Number : 1962781971 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962781971",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PROVISO LEYDEN COUNCIL FOR COMMUNITY ACTION",
    "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": "411 MADISON ST",
    "SecondLineMailingAddress": "PO BOX 950",
    "MailingAddressCityName": "MAYWOOD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60153-2136",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-450-3500",
    "MailingAddressFaxNumber": "708-236-5189",
    "FirstLinePracticeLocationAddress": "411 MADISON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MAYWOOD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60153-2136",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "708-450-3500",
    "PracticeLocationAddressFaxNumber": "708-236-5189",
    "EnumerationDate": "08/08/2011",
    "LastUpdateDate": "08/08/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "COKER",
    "AuthorizedOfficialFirstName": "EVELYN",
    "AuthorizedOfficialMiddleName": "JOY",
    "AuthorizedOfficialTitle": "DIR. OF CLINICAL & SOCIAL SERVICES",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "L.C.S.W.",
    "AuthorizedOfficialTelephoneNumber": "708-450-3500",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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