{
"Npi": {
"NPI": "1225469844",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "NATIONAL MENTOR SERVICES, LLC",
"ParentOrgTIN": null,
"OrgName": "NATIONAL MENTOR HEALTHCARE, 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": "9375 DIELMAN INDUSTRIAL DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OLIVETTE",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63132-2212",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-991-7944",
"MailingAddressFaxNumber": "314-991-6642",
"FirstLinePracticeLocationAddress": "9375 DIELMAN INDUSTRIAL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OLIVETTE",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63132-2212",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-991-7944",
"PracticeLocationAddressFaxNumber": "314-991-6642",
"EnumerationDate": "12/07/2013",
"LastUpdateDate": "03/05/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COHEN",
"AuthorizedOfficialFirstName": "BRETT",
"AuthorizedOfficialMiddleName": "IAN",
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "800-388-5150",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": "8002126",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}