{
"Npi": {
"NPI": "1134599590",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MORAVIAN FAMILY CARE HOME",
"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": "7604 FAIRHAVEN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROWNS SUMMIT",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27214-9643",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-554-3486",
"MailingAddressFaxNumber": "336-358-1729",
"FirstLinePracticeLocationAddress": "2905 HOLMES RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENSBORO",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27405-4621",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-554-3486",
"PracticeLocationAddressFaxNumber": "336-554-3486",
"EnumerationDate": "09/29/2015",
"LastUpdateDate": "09/29/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MORAVIAN",
"AuthorizedOfficialFirstName": "MEGAN",
"AuthorizedOfficialMiddleName": "COMMEDO",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "336-554-3486",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": "041-1025",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}