{
"Npi": {
"NPI": "1255658506",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CQC HOME HEALTH AGENCY, INC.",
"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": "1523 WEATHERSTONE LN",
"SecondLineMailingAddress": "LOWER LEVEL",
"MailingAddressCityName": "ELGIN",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60123-2064",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-888-1055",
"MailingAddressFaxNumber": "847-888-1060",
"FirstLinePracticeLocationAddress": "1523 WEATHERSTONE LN",
"SecondLinePracticeLocationAddress": "LOWER LEVEL",
"PracticeLocationAddressCityName": "ELGIN",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60123-2064",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "847-888-1055",
"PracticeLocationAddressFaxNumber": "847-888-1060",
"EnumerationDate": "04/27/2010",
"LastUpdateDate": "04/27/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAVIS",
"AuthorizedOfficialFirstName": "ZINNIA",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "ADMINSTRATOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "847-888-1055",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "1011194",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}