{
"Npi": {
"NPI": "1093066912",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIVE 4 LIFE INC",
"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": "2911 TURNER RD",
"SecondLineMailingAddress": "ST B6",
"MailingAddressCityName": "NORTH CHESTERFIELD",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23224-2545",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-447-7235",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2911 TURNER RD",
"SecondLinePracticeLocationAddress": "ST B6",
"PracticeLocationAddressCityName": "NORTH CHESTERFIELD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23224-2545",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-447-7235",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/02/2012",
"LastUpdateDate": "03/06/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JACKSON",
"AuthorizedOfficialFirstName": "JASON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "757-816-7842",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}