{
"Npi": {
"NPI": "1154772762",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GREENLINE HEALTH SERVICES, INC",
"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": "7360 HOBGOOD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRBURN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30213-2684",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-885-9765",
"MailingAddressFaxNumber": "678-885-9764",
"FirstLinePracticeLocationAddress": "1572 HIGHWAY 85 N",
"SecondLinePracticeLocationAddress": "SUITE 338",
"PracticeLocationAddressCityName": "FAYETTEVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30214",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "678-885-9765",
"PracticeLocationAddressFaxNumber": "678-885-9764",
"EnumerationDate": "06/24/2016",
"LastUpdateDate": "04/20/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FULLER",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "678-463-4666",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "060-R-1398",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}