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1982881702 NPI number — PEACEFUL HAVEN RANCH GROUP HOME

NPI Number: 1982881702
Health Care Provider/Practitioner: PEACEFUL HAVEN RANCH GROUP HOME

Information about “1982881702” NPI (PEACEFUL HAVEN RANCH GROUP HOME) exists in 1982881702 in HTML format HTML  |  1982881702 in plain Text format TXT  |  1982881702 in PDF (Portable Document Format) PDF  |  1982881702 in an XML format XML  formats.

NPI Number : 1982881702 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1982881702",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PEACEFUL HAVEN RANCH GROUP HOME",
    "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": "12601 STIRLING RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHWEST RANCHES",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33330-3215",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-689-0151",
    "MailingAddressFaxNumber": "954-680-9474",
    "FirstLinePracticeLocationAddress": "12601 STIRLING RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTHWEST RANCHES",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33330-3215",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-689-0151",
    "PracticeLocationAddressFaxNumber": "954-680-9474",
    "EnumerationDate": "01/23/2008",
    "LastUpdateDate": "01/23/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FERNANDEZ",
    "AuthorizedOfficialFirstName": "ALBERTO",
    "AuthorizedOfficialMiddleName": "E",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "954-689-0151",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "320600000X",
          "TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
          "LicenseNumber": "10-1607GH",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "320600000X",
          "TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
          "LicenseNumber": "10-1606GH",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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