{
"Npi": {
"NPI": "1033519897",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LOYAL SERVICE AGENCY INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "103 GOLTZ DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRANTS",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87020-2155",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-285-2966",
"MailingAddressFaxNumber": "505-285-4055",
"FirstLinePracticeLocationAddress": "103 GOLTZ DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRANTS",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "87020-2155",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-285-2966",
"PracticeLocationAddressFaxNumber": "505-285-4055",
"EnumerationDate": "08/29/2014",
"LastUpdateDate": "08/29/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SANDOVAL-ASEBEDO",
"AuthorizedOfficialFirstName": "LONNEL",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.N.",
"AuthorizedOfficialTelephoneNumber": "505-285-2966",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "3351",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}