{
"Npi": {
"NPI": "1013194497",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AMERICAN STAR HOME 3 ICF/DD-N",
"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": "2009 FITZGERALD WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRENTWOOD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94513",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "925-813-1979",
"MailingAddressFaxNumber": "925-420-6748",
"FirstLinePracticeLocationAddress": "125 BROWNSTONE ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OAKLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94561-5900",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "925-625-7354",
"PracticeLocationAddressFaxNumber": "925-625-7384",
"EnumerationDate": "01/28/2008",
"LastUpdateDate": "02/24/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TING",
"AuthorizedOfficialFirstName": "VICKY",
"AuthorizedOfficialMiddleName": "SANTOS",
"AuthorizedOfficialTitle": "PRESIDENT/ADMINISTRATOR/OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BSN",
"AuthorizedOfficialTelephoneNumber": "925-813-1979",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}