{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "FAITH INDEPENDENCE 3A INC",
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"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "456 CANBY CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OCOEE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34761-8903",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-309-0481",
"MailingAddressFaxNumber": "407-641-9799",
"FirstLinePracticeLocationAddress": "456 CANBY CIR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OCOEE",
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"PracticeLocationAddressTelephoneNumber": "407-309-0481",
"PracticeLocationAddressFaxNumber": "407-641-9799",
"EnumerationDate": "09/28/2021",
"LastUpdateDate": "09/28/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "LUE JIMMIE",
"AuthorizedOfficialMiddleName": "FILLICIA",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "407-309-0481",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}