{
"Npi": {
"NPI": "1124922406",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "UPSIDIAN CARE NETWORK, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "200 UNIVERSITY AVE SE UNIT 2403",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MINNEAPOLIS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55414-2475",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-552-3066",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1128 HARMON PL STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MINNEAPOLIS",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55403-2074",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "612-552-3066",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/08/2026",
"LastUpdateDate": "10/08/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FONGE",
"AuthorizedOfficialFirstName": "YANEVE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "FOUNDER AND CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "203-668-9057",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "374J00000X",
"TaxonomyName": "Doula",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}