{
"Npi": {
"NPI": "1245643337",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AMERICAN CTR FOR INTELLECTUAL AND DEV. DISABILITIES IN MD, 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": "5999 HARPERS FARM RD",
"SecondLineMailingAddress": "SUITE E-250",
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21044-3013",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "443-319-5010",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8980 OLD ANNAPOLIS RD",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21045-2115",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-319-5010",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/05/2014",
"LastUpdateDate": "05/16/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATHEW",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "443-718-7031",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}