{
"Npi": {
"NPI": "1033814496",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TROST HEALTH CA LLC",
"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": "120 N FEDERAL HWY STE 206",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKE WORTH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33460-3493",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-400-1556",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3017 DOUGLAS BLVD, SUITE 300",
"SecondLinePracticeLocationAddress": "OFFICE #69",
"PracticeLocationAddressCityName": "ROSEVILLE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95661-3848",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-891-6218",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/04/2023",
"LastUpdateDate": "12/20/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TURNER",
"AuthorizedOfficialFirstName": "JARED",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BILLING MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "772-812-9652",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0405X",
"TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}