{
"Npi": {
"NPI": "1205011335",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AQUILA HEALTHCARE SYSTEMS, LLC",
"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": "400 CORPORATE POINTE STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CULVER CITY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90230-7620",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "213-380-1399",
"MailingAddressFaxNumber": "323-380-4046",
"FirstLinePracticeLocationAddress": "3450 WILSHIRE BLVD",
"SecondLinePracticeLocationAddress": "SUITE 1000",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90010-2208",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "213-380-1399",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/08/2008",
"LastUpdateDate": "02/02/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARK",
"AuthorizedOfficialFirstName": "DAMON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "213-380-1399",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "980000772",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}