{
"Npi": {
"NPI": "1013251511",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ACTS SIGNATURE COMMUNITY SERVICES",
"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": "2250 INDIAN CREEK BLVD W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VERO BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32966-1331",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "772-778-3828",
"MailingAddressFaxNumber": "772-770-0898",
"FirstLinePracticeLocationAddress": "2250 INDIAN CREEK BLVD W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VERO BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32966-1331",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "772-778-3828",
"PracticeLocationAddressFaxNumber": "772-770-0898",
"EnumerationDate": "11/21/2012",
"LastUpdateDate": "10/08/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLANCY",
"AuthorizedOfficialFirstName": "CHERYL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "561-362-0669",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": "299991089",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}