{
"Npi": {
"NPI": "1114155439",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VA HEALTH CARE SYSTEM",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "795 WILLOW ROAD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MENLO PARK",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94025",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "650-493-5000",
"MailingAddressFaxNumber": "650-617-2614",
"FirstLinePracticeLocationAddress": "3801 MIRANDA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PALO ALTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94304-1207",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "650-493-5000",
"PracticeLocationAddressFaxNumber": "650-617-2614",
"EnumerationDate": "06/25/2009",
"LastUpdateDate": "06/25/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MYERS",
"AuthorizedOfficialFirstName": "DORETHA",
"AuthorizedOfficialMiddleName": "JEAN",
"AuthorizedOfficialTitle": "CLINICAL SOCIAL WORKER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P-LCSW",
"AuthorizedOfficialTelephoneNumber": "650-493-5000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "283Q00000X",
"TaxonomyName": "Psychiatric Hospital",
"LicenseNumber": "P003597",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}