{
"Npi": {
"NPI": "1215352067",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NU GENESIS YOUTH AND PROFESSIONAL DEVELOPMENT SERVICES, 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": "2451 HANOVER CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WALDORF",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20601-5302",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-517-4784",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2451 HANOVER CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WALDORF",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20601-5302",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-517-4784",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/03/2014",
"LastUpdateDate": "03/03/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCLEAN",
"AuthorizedOfficialFirstName": "MARGIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT AND CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "804-517-4784",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}