{
"Npi": {
"NPI": "1124509633",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GREY HAVENS, 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 20066",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOULDER",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80308-3066",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-817-4703",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "12570 COUNTY ROAD 34",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PLATTEVILLE",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80651-8314",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-785-2819",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/23/2018",
"LastUpdateDate": "08/23/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOWE",
"AuthorizedOfficialFirstName": "LORIEN",
"AuthorizedOfficialMiddleName": "KATHLEEN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CNA",
"AuthorizedOfficialTelephoneNumber": "303-817-4703",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "376K00000X",
"TaxonomyName": "Nurse's Aide",
"LicenseNumber": "NA.00749790",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}