{
"Npi": {
"NPI": "1245303049",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEW LIFE COMMUNITY ADULT DAYCARE INC.",
"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": "PO BOX 5183",
"SecondLineMailingAddress": "166 PARK AVE W. SUITE 207",
"MailingAddressCityName": "MANSFIELD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44901",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-522-3900",
"MailingAddressFaxNumber": "419-522-8300",
"FirstLinePracticeLocationAddress": "166 PARK AVE W",
"SecondLinePracticeLocationAddress": "166 PARK AVE W. SUITE 207",
"PracticeLocationAddressCityName": "MANSFIELD",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44902-1637",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-522-3900",
"PracticeLocationAddressFaxNumber": "419-522-8300",
"EnumerationDate": "11/17/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MELTON",
"AuthorizedOfficialFirstName": "LENORE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "STATORY AGENT",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "419-522-3900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}