{
"Npi": {
"NPI": "1245807676",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RELYANCE HOME CARE SOLUTIONS, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "530 THOMAS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAMILLA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31730-2318",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "229-854-8497",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "155 W RAILROAD ST S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PELHAM",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31779-1631",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "229-854-8497",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/04/2021",
"LastUpdateDate": "06/09/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAVIS",
"AuthorizedOfficialFirstName": "AKINA",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "ADMINISTRATOR/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "229-854-8497",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3140N1450X",
"TaxonomyName": "Pediatric Skilled Nursing Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "347C00000X",
"TaxonomyName": "Private Vehicle",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}