{
"Npi": {
"NPI": "1225164676",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CROCKETT HEALTH CARE ASSOCIATES, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "100 NE LOOP 304",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CROCKETT",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75835-5344",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "936-544-7884",
"MailingAddressFaxNumber": "936-544-4098",
"FirstLinePracticeLocationAddress": "100 NE LOOP 304",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CROCKETT",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75835-5344",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "936-544-7884",
"PracticeLocationAddressFaxNumber": "936-544-4098",
"EnumerationDate": "02/27/2007",
"LastUpdateDate": "03/23/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAKER",
"AuthorizedOfficialFirstName": "DENNIS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR, OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "936-544-7884",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": "117894",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}