{
"Npi": {
"NPI": "1053811257",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CUSTOM CARE CONSULTANTS, 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": "1403 VAN BUREN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OXFORD",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38655-4091",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1403 VAN BUREN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OXFORD",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38655-4091",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-813-9535",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/15/2018",
"LastUpdateDate": "02/15/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCINNIS",
"AuthorizedOfficialFirstName": "ELLIS",
"AuthorizedOfficialMiddleName": "WINTON",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "IV",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "601-813-9535",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": "1066035",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}