{
"Npi": {
"NPI": "1174861108",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LEISURE CARE HOME CARE AGENCY, 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": "30131 TOWN CENTER DR",
"SecondLineMailingAddress": "SUITE 205",
"MailingAddressCityName": "LAGUNA NIGUEL",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92677-2034",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-363-7401",
"MailingAddressFaxNumber": "949-363-7419",
"FirstLinePracticeLocationAddress": "30131 TOWN CENTER DR",
"SecondLinePracticeLocationAddress": "SUITE 205",
"PracticeLocationAddressCityName": "LAGUNA NIGUEL",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92677-2034",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-363-7401",
"PracticeLocationAddressFaxNumber": "949-363-7419",
"EnumerationDate": "01/25/2013",
"LastUpdateDate": "01/25/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLACKANN",
"AuthorizedOfficialFirstName": "TREVOR",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "949-363-7401",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": "C-2616981",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}