{
"Npi": {
"NPI": "1154557809",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANGEL WATCH HOME CARE, INC.",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3854 AMERICAN WAY",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "BATON ROUGE",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70816-4013",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "225-292-2031",
"MailingAddressFaxNumber": "225-295-9678",
"FirstLinePracticeLocationAddress": "1869 S. 8TH STREET",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "FERNANDINA BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32034-3072",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-491-3222",
"PracticeLocationAddressFaxNumber": "904-491-3211",
"EnumerationDate": "06/09/2009",
"LastUpdateDate": "09/27/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KUSSEROW",
"AuthorizedOfficialFirstName": "PAUL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "225-292-2031",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "299993523",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}