{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
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"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6099 GULF RD N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32244-2522",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-545-8002",
"MailingAddressFaxNumber": "904-723-1829",
"FirstLinePracticeLocationAddress": "6099 GULF RD N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-545-8002",
"PracticeLocationAddressFaxNumber": "904-723-1829",
"EnumerationDate": "01/31/2017",
"LastUpdateDate": "01/31/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAGAN",
"AuthorizedOfficialFirstName": "BESSIE",
"AuthorizedOfficialMiddleName": "ELIZABETH",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "904-545-8002",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Respite Care",
"LicenseNumber": "234002",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}