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1972029353 NPI number — CHERUB ENTERPRISES

NPI Number: 1972029353
Health Care Provider/Practitioner: CHERUB ENTERPRISES

Information about “1972029353” NPI (CHERUB ENTERPRISES) exists in 1972029353 in HTML format HTML  |  1972029353 in plain Text format TXT  |  1972029353 in PDF (Portable Document Format) PDF  |  1972029353 in an XML format XML  formats.

NPI Number : 1972029353 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972029353",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CHERUB ENTERPRISES",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5413 S WESTNEDGE AVE STE D-E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTAGE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49002-0453",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "269-459-6464",
    "MailingAddressFaxNumber": "269-348-0079",
    "FirstLinePracticeLocationAddress": "5413 S WESTNEDGE AVE STE D-E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTAGE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49002-0453",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "269-459-6464",
    "PracticeLocationAddressFaxNumber": "269-348-0079",
    "EnumerationDate": "08/17/2017",
    "LastUpdateDate": "04/10/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KLUCK",
    "AuthorizedOfficialFirstName": "ELLEN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "269-459-6464",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "385H00000X",
          "TaxonomyName": "Respite Care",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "253Z00000X",
          "TaxonomyName": "In Home Supportive Care Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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