{
"Npi": {
"NPI": "1023298718",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANT MARYS FAMILY CARE INC",
"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": "PO BOX 516",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LA GRANGE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28551-0516",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3713 ED HERRING RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LA GRANGE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28551-8331",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-344-9903",
"PracticeLocationAddressFaxNumber": "252-566-3598",
"EnumerationDate": "11/09/2007",
"LastUpdateDate": "02/28/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CONYERS",
"AuthorizedOfficialFirstName": "EULA",
"AuthorizedOfficialMiddleName": "MAE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "919-344-9903",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": "FCL054059",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}