{
"Npi": {
"NPI": "1114055464",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROMEDICAL HEALTH CARE",
"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": "1597 KNIGHT ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHOREVIEW",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55126-4571",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-644-5764",
"MailingAddressFaxNumber": "952-841-6301",
"FirstLinePracticeLocationAddress": "1597 KNIGHT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SHOREVIEW",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55126-4571",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "612-644-5764",
"PracticeLocationAddressFaxNumber": "952-841-6301",
"EnumerationDate": "03/01/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARLEY",
"AuthorizedOfficialFirstName": "KASHIF",
"AuthorizedOfficialMiddleName": "ALEXANDER",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "612-644-5764",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "335372",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}