{
"Npi": {
"NPI": "1134709561",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "LOVE OF GRACE PNCC SERVICES LLC",
"ParentOrgTIN": null,
"OrgName": "LOVE OF GRACE ADULT SERVICES",
"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": "4556 N 41ST ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILWAUKEE",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53209-5818",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-281-1574",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4556 N 41ST ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MILWAUKEE",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53209-5818",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-281-1574",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/09/2021",
"LastUpdateDate": "02/27/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FREEMAN",
"AuthorizedOfficialFirstName": "TAMIA",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "800-796-0419",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "311Z00000X",
"TaxonomyName": "Custodial Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}