{
"Npi": {
"NPI": "1174532592",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PRESCRIPTION SUPPLY INC",
"ParentOrgTIN": null,
"OrgName": "LTC LEONARD LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2233 TRACY RD STE B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTHWOOD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43619-1302",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "517-787-2132",
"MailingAddressFaxNumber": "517-787-0316",
"FirstLinePracticeLocationAddress": "303 W PROSPECT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSON",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49203-4113",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "517-787-2132",
"PracticeLocationAddressFaxNumber": "517-787-0316",
"EnumerationDate": "08/05/2006",
"LastUpdateDate": "04/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHOEN",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "VICE PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "419-654-1973",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "5301001041",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "5301001041",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}