{
"Npi": {
"NPI": "1205564549",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CRENSHAW ENTREPRENEURIAL ACADEMY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "206 W 1ST ST UNIT 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN PEDRO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90731-2806",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "424-450-7412",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5125 CRENSHAW BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90043-1853",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "424-450-7412",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/14/2022",
"LastUpdateDate": "08/14/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOPEZ",
"AuthorizedOfficialFirstName": "TIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "424-450-7412",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251C00000X",
"TaxonomyName": "Developmentally Disabled Services Day Training Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QD1600X",
"TaxonomyName": "Developmental Disabilities Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}