{
"Npi": {
"NPI": "1245458421",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT",
"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": "733 CEDAR ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GARBERVILLE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95542-3201",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-923-3921",
"MailingAddressFaxNumber": "707-923-1456",
"FirstLinePracticeLocationAddress": "733 CEDAR ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GARBERVILLE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95542-3201",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-923-3921",
"PracticeLocationAddressFaxNumber": "707-923-1456",
"EnumerationDate": "04/23/2007",
"LastUpdateDate": "01/18/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REES",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "707-923-3921",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "110000052",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}