{
"Npi": {
"NPI": "1124236724",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PEABODY RESIDENT SERVICES INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "536 GRANITE STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRAINTREE",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02184",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "781-794-1000",
"MailingAddressFaxNumber": "781-794-1087",
"FirstLinePracticeLocationAddress": "536 GRANITE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRAINTREE",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02184-3952",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "781-794-1000",
"PracticeLocationAddressFaxNumber": "781-794-1087",
"EnumerationDate": "05/18/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUSHASHIA",
"AuthorizedOfficialFirstName": "DOREEN",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "DIRECTOR OF RESIDENT SERVICES",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "781-794-1000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": "1902563",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}