Louise Graham Regeneration Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LOUISE GRAHAM REGENERATION CENTER

Practice address

2301 3Rd Ave S
St Petersburg, FL 33712-1646

Phone

(727) 327-9444

Fax

(727) 327-9649

NPI assigned

Feb 9, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Arthur O'Hara

Title

Executive Director

Phone

(727) 578-5437

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297209600000",
    "number": "1730485749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 3RD AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337121646",
            "telephone_number": "727-327-9444",
            "fax_number": "727-327-9649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 3RD AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337121646",
            "telephone_number": "727-327-9444",
            "fax_number": "727-327-9649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISE GRAHAM REGENERATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-09",
        "last_updated": "2011-02-09",
        "status": "A",
        "authorized_official_last_name": "O'HARA",
        "authorized_official_first_name": "ARTHUR",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "727-578-5437",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024019201",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024019296",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.