{
"Npi": {
"NPI": "1255744371",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JEREMIAH COMMUNITY OUTREACH SERVICES, 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": "935 175TH ST",
"SecondLineMailingAddress": "SUITE 302",
"MailingAddressCityName": "HOMEWOOD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60430-2049",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-914-4248",
"MailingAddressFaxNumber": "708-991-2975",
"FirstLinePracticeLocationAddress": "935 175TH ST",
"SecondLinePracticeLocationAddress": "SUITE 302",
"PracticeLocationAddressCityName": "HOMEWOOD",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60430-2049",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-914-4248",
"PracticeLocationAddressFaxNumber": "708-991-2975",
"EnumerationDate": "06/05/2014",
"LastUpdateDate": "06/05/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLLADAY",
"AuthorizedOfficialFirstName": "SHIRLEY",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CADC",
"AuthorizedOfficialTelephoneNumber": "708-914-4248",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "A52410001A",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}