{
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"LastName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "PO BOX 535",
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"MailingAddressCityName": "CHESTER",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21619-0535",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1563 POSTAL RD STE 3B",
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"PracticeLocationAddressCityName": "CHESTER",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/03/2016",
"LastUpdateDate": "09/27/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCAULEY",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "RESPITE PROJECT SUPERVISOR",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "443-880-3887",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "385H00000X",
"TaxonomyName": "Respite Care",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}