{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1545 N VERDUGO RD STE 108",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLENDALE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91208-2858",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "747-215-6714",
"MailingAddressFaxNumber": "747-215-2372",
"FirstLinePracticeLocationAddress": "1545 N VERDUGO RD STE 108",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLENDALE",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-422-3919",
"PracticeLocationAddressFaxNumber": "855-382-5717",
"EnumerationDate": "06/06/2017",
"LastUpdateDate": "08/16/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOURADIAN",
"AuthorizedOfficialFirstName": "EDWARD",
"AuthorizedOfficialMiddleName": null,
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"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "747-215-6714",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}