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1972972560 NPI number — SOUTH SHORES DETOXLLC

NPI Number: 1972972560
Health Care Provider/Practitioner: SOUTH SHORES DETOXLLC

Information about “1972972560” NPI (SOUTH SHORES DETOXLLC) exists in 1972972560 in HTML format HTML  |  1972972560 in plain Text format TXT  |  1972972560 in PDF (Portable Document Format) PDF  |  1972972560 in an XML format XML  formats.

NPI Number : 1972972560 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972972560",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SOUTH SHORES DETOXLLC",
    "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": "31746 VIA BELARDES",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN JUAN CAPISTRANO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92675-3031",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "949-289-2138",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "27568 VISTA DE DONS",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DANA POINT",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92624-1843",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "949-218-2347",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/24/2015",
    "LastUpdateDate": "09/24/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SMITH",
    "AuthorizedOfficialFirstName": "JOSH",
    "AuthorizedOfficialMiddleName": "D",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "949-289-2138",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "324500000X",
        "TaxonomyName": "Substance Abuse Rehabilitation Facility",
        "LicenseNumber": "300324AP",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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