{
"Npi": {
"NPI": "1174769335",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MILLENNIUM HEALTH CARE SERVICES",
"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": "PO BOX 45301",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BATON ROUGE",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70895",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "225-923-3117",
"MailingAddressFaxNumber": "225-923-3118",
"FirstLinePracticeLocationAddress": "1920 FLORIDA BLVD",
"SecondLinePracticeLocationAddress": "SUITE F",
"PracticeLocationAddressCityName": "DENHAM SPRINGS",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70726-4970",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "225-667-7626",
"PracticeLocationAddressFaxNumber": "225-667-7627",
"EnumerationDate": "12/18/2008",
"LastUpdateDate": "12/18/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOODS",
"AuthorizedOfficialFirstName": "DWAINE",
"AuthorizedOfficialMiddleName": "JOSEPH",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "SR.",
"AuthorizedOfficialCredential": "MBA",
"AuthorizedOfficialTelephoneNumber": "225-923-3117",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3747P1801X",
"TaxonomyName": "Personal Care Attendant",
"LicenseNumber": "PCA 15142",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}