{
"Npi": {
"NPI": "1255665436",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAKA SIL & GROUP HOME, 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": "24123 GREENFIELD RD",
"SecondLineMailingAddress": "STE 307",
"MailingAddressCityName": "SOUTHFIELD",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48075-3125",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-595-8108",
"MailingAddressFaxNumber": "248-595-8237",
"FirstLinePracticeLocationAddress": "24123 GREENFIELD RD",
"SecondLinePracticeLocationAddress": "STE 307",
"PracticeLocationAddressCityName": "SOUTHFIELD",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48075-3125",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-595-8108",
"PracticeLocationAddressFaxNumber": "248-595-8237",
"EnumerationDate": "09/22/2009",
"LastUpdateDate": "07/10/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "RAYMOND",
"AuthorizedOfficialMiddleName": "KYLE",
"AuthorizedOfficialTitle": "ASSISTANT DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "313-347-6334",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}