{
"Npi": {
"NPI": "1063570547",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "BRANDON RESIDENTIAL TREATMENT CENTER, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "27 WINTER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NATICK",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01760-1015",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "508-655-6400",
"MailingAddressFaxNumber": "508-650-9431",
"FirstLinePracticeLocationAddress": "27 WINTER ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NATICK",
"PracticeLocationAddressStateName": "MA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "508-655-6400",
"PracticeLocationAddressFaxNumber": "508-650-9431",
"EnumerationDate": "12/05/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CALLAHAN",
"AuthorizedOfficialFirstName": "TIMOTHY",
"AuthorizedOfficialMiddleName": "M.",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "ED.D.",
"AuthorizedOfficialTelephoneNumber": "508-655-6400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "322D00000X",
"TaxonomyName": "Emotionally Disturbed Childrens' Residential Treatment Facility",
"LicenseNumber": "4903992",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}