{
"Npi": {
"NPI": "1124405840",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WILLIE MAE CLERK ADULT DAY CARE ,LLC",
"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": "PO BOX 155",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOYLE",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38730-0155",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-846-7732",
"MailingAddressFaxNumber": "662-846-7732",
"FirstLinePracticeLocationAddress": "151 GAINES HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOYLE",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38730-9512",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-846-7732",
"PracticeLocationAddressFaxNumber": "662-846-7732",
"EnumerationDate": "05/01/2015",
"LastUpdateDate": "05/01/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLERK",
"AuthorizedOfficialFirstName": "JOSEPHINE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MISS",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "662-846-7732",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": "08133227",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}