{
"Npi": {
"NPI": "1043553407",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "BETHANY CHRISTIAN SERVICES",
"ParentOrgTIN": null,
"OrgName": "BETHANY CHRISTIAN SERVICES",
"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": "1681 CROWN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LANCASTER",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17601-6303",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-858-0180",
"MailingAddressFaxNumber": "717-399-3543",
"FirstLinePracticeLocationAddress": "1681 CROWN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LANCASTER",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17601-6303",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-858-0180",
"PracticeLocationAddressFaxNumber": "717-399-3543",
"EnumerationDate": "04/03/2013",
"LastUpdateDate": "04/03/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ORTIZ",
"AuthorizedOfficialFirstName": "MELISSA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BRANCH DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LSW",
"AuthorizedOfficialTelephoneNumber": "610-858-0180",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "SW126483",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}