{
"Npi": {
"NPI": "1275541500",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JERUSALEN HOME AMBULANCE, 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": "PO BOX 1780",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAGUAS",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00726-1780",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-653-2225",
"MailingAddressFaxNumber": "787-653-1720",
"FirstLinePracticeLocationAddress": "AVE LUIS MUNOZ MARIN ESQUINA GEORGETTI",
"SecondLinePracticeLocationAddress": "ANGORA PARK PLAZA",
"PracticeLocationAddressCityName": "CAGUAS",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00725",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-653-1717",
"PracticeLocationAddressFaxNumber": "787-653-1720",
"EnumerationDate": "08/03/2006",
"LastUpdateDate": "02/21/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ORTIZ",
"AuthorizedOfficialFirstName": "LUIS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "787-653-2225",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "TCAMB-164",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "TCAMB-361",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}