{
"Npi": {
"NPI": "1053876805",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EDEN SENIOR CARE SERVICES 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": "6606 OKEEFE KNOLL CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRFAX STATION",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22039-1864",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "571-439-9005",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15120 ENTERPRISE CT STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHANTILLY",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "20151-1274",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "240-377-6760",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/06/2019",
"LastUpdateDate": "05/05/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCARLETT",
"AuthorizedOfficialFirstName": "ISABEL",
"AuthorizedOfficialMiddleName": "H",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "703-828-7545",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}