{
"Npi": {
"NPI": "1205006673",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PENJAMO 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": "PO BOX 1758",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALICE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78333-1758",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "361-562-1068",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "308 COUNTY ROAD 140",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALICE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78332-7636",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "361-562-1068",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/02/2008",
"LastUpdateDate": "06/30/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SILVA",
"AuthorizedOfficialFirstName": "LUIS",
"AuthorizedOfficialMiddleName": "ALONSO",
"AuthorizedOfficialTitle": "DIR OF PAS",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "361-562-1068",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "010736",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}