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1992172340 NPI number — LIGHT OF THE WORLD REHABILITATION & RECOVERY SERVICES LLC

NPI Number: 1992172340
Health Care Provider/Practitioner: LIGHT OF THE WORLD REHABILITATION & RECOVERY SERVICES LLC

Information about “1992172340” NPI (LIGHT OF THE WORLD REHABILITATION & RECOVERY SERVICES LLC) exists in 1992172340 in HTML format HTML  |  1992172340 in plain Text format TXT  |  1992172340 in PDF (Portable Document Format) PDF  |  1992172340 in an XML format XML  formats.

NPI Number : 1992172340 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992172340",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LIGHT OF THE WORLD REHABILITATION & RECOVERY SERVICES LLC",
    "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": "2100 LAKE IDA RD STE 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DELRAY BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33445-2442",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "305-310-6618",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2100 LAKE IDA RD STE 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DELRAY BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33445-2442",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-310-6618",
    "PracticeLocationAddressFaxNumber": "561-330-5268",
    "EnumerationDate": "09/01/2015",
    "LastUpdateDate": "05/31/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SCHMIDT",
    "AuthorizedOfficialFirstName": "KEVIN",
    "AuthorizedOfficialMiddleName": "BLAINE",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LCSW, BACC",
    "AuthorizedOfficialTelephoneNumber": "305-310-6618",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QR0405X",
        "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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