{
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"IsOrgSubpart": "N",
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"OrgName": "CARE CREST",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15365 HILL CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROSEVILLE",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48066-3119",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-879-0114",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15365 HILL CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROSEVILLE",
"PracticeLocationAddressStateName": "MI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-879-0114",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/17/2015",
"LastUpdateDate": "01/11/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIVANS",
"AuthorizedOfficialFirstName": "THERICA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "HEALTHCARE ADMINISTRATOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "313-421-9835",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "632127",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}