{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHUCKS HOME CARE AGENCY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "632 OLIVE LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AMBRIDGE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15003-2458",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-680-5206",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "416 E 5TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAST LIVERPOOL",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43920-3134",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "724-252-6084",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/16/2021",
"LastUpdateDate": "09/16/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIMMONS",
"AuthorizedOfficialFirstName": "SHEREKA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": "MISS",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "724-680-5206",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}