{
"Npi": {
"NPI": "1043450950",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GOOD SAMARITAN SOCIETY HCBS-TX, LLC",
"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": "700 N TOWN EAST BLVD APT 159",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MESQUITE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75150-4793",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-686-4366",
"MailingAddressFaxNumber": "972-686-4372",
"FirstLinePracticeLocationAddress": "607 W MAGNOLIA AVE STE 205",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT WORTH",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76104-4608",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-686-4366",
"PracticeLocationAddressFaxNumber": "972-686-4372",
"EnumerationDate": "03/05/2009",
"LastUpdateDate": "11/01/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TRIBBLE",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "GRANT",
"AuthorizedOfficialTitle": "TREASURER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "605-362-3900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}