{
"Npi": {
"NPI": "1174995211",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COASTLINE HEALTHCARE SOLUTIONS, INC.",
"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": "23046 AVENIDA DE LA CARLOTA",
"SecondLineMailingAddress": "SUITE 600",
"MailingAddressCityName": "LAGUNA HILLS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92653-1548",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "855-426-2785",
"MailingAddressFaxNumber": "855-426-2785",
"FirstLinePracticeLocationAddress": "23046 AVENIDA DE LA CARLOTA",
"SecondLinePracticeLocationAddress": "SUITE 600",
"PracticeLocationAddressCityName": "LAGUNA HILLS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92653-1548",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "855-426-2785",
"PracticeLocationAddressFaxNumber": "855-426-2785",
"EnumerationDate": "10/28/2015",
"LastUpdateDate": "10/28/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JUHL",
"AuthorizedOfficialFirstName": "VINCENT",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "CO- FOUNDER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "855-426-2785",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": "C3581553",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}