{
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"FirstLineMailingAddress": "154 E BROADWAY ST",
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"MailingAddressCityName": "MONTICELLO",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-212-1256",
"MailingAddressFaxNumber": "833-553-1218",
"FirstLinePracticeLocationAddress": "154 E BROADWAY ST",
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"PracticeLocationAddressCityName": "MONTICELLO",
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"EnumerationDate": "04/20/2026",
"LastUpdateDate": "04/20/2026",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MBONG",
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"AuthorizedOfficialTelephoneNumber": "612-212-1256",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}