{
"Npi": {
"NPI": "1255571089",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRESTIGE HEALTHCARE SERVICES OF ILLINOIS",
"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": "17900 DIXIE HIGHWAY",
"SecondLineMailingAddress": "SUITE",
"MailingAddressCityName": "HOMEWOOD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60430",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-798-2350",
"MailingAddressFaxNumber": "708-798-2355",
"FirstLinePracticeLocationAddress": "17900 DIXIE HIGHWAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOMEWOOD",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60430",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-798-2350",
"PracticeLocationAddressFaxNumber": "708-798-2355",
"EnumerationDate": "03/06/2009",
"LastUpdateDate": "03/23/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NWAGBARA",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "I",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "708-798-2350",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}