{
"Npi": {
"NPI": "1275959728",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TIKVAH CENTER",
"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": "22930 CANYON VIEW DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORONA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92883-9148",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-254-9736",
"MailingAddressFaxNumber": "951-254-9737",
"FirstLinePracticeLocationAddress": "22930 CANYON VIEW DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORONA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92883-9148",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-254-9736",
"PracticeLocationAddressFaxNumber": "951-254-9737",
"EnumerationDate": "03/07/2014",
"LastUpdateDate": "03/07/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FLORES",
"AuthorizedOfficialFirstName": "LILLY",
"AuthorizedOfficialMiddleName": "ALEJANDRA",
"AuthorizedOfficialTitle": "OWNER/DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "B.C.B.A.",
"AuthorizedOfficialTelephoneNumber": "626-757-4940",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "1-10-7080",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}