{
"Npi": {
"NPI": "1073787768",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LA CASA SERENA",
"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": "324 E 1ST STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAGAR",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85925-0609",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "928-333-0151",
"MailingAddressFaxNumber": "928-333-0154",
"FirstLinePracticeLocationAddress": "324 EAST 1ST STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAGAR",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85925-0609",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "928-333-0151",
"PracticeLocationAddressFaxNumber": "928-333-0154",
"EnumerationDate": "04/15/2008",
"LastUpdateDate": "04/15/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAMBLIN",
"AuthorizedOfficialFirstName": "ERIC",
"AuthorizedOfficialMiddleName": "LEE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "928-333-0151",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "AL6954",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}