The Source of Americallc

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

THE SOURCE OF AMERICALLC

Doing business as

the source d.a.g.

Practice address

5301 Goddard Ave
Orlando, FL 32810-5437

Phone

(407) 715-6807

NPI assigned

Apr 10, 2012

Last updated

Apr 10, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Rick White Sr.NPI 1609167220

Title

Director

Phone

(904) 703-4364

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• the source d.a.g. Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rick White Sr.

  • Case Management Agency
  • Oklahoma City, OK
  • NPI 1609167220
  Authorized official Same address or phone

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334016000000",
    "number": "1942566393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 GODDARD AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328105437",
            "telephone_number": "407-715-6807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 GODDARD AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328105437",
            "telephone_number": "407-715-6807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SOURCE OF AMERICALLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2012-04-10",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "RICK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-703-4364",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RAENISHA22",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "the source d.a.g.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Counselor in Orlando, FL
• Providers in Orlando, FL by specialty
• Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; 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.