{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "NUESTROS ANGELES DE LA GUARDIA PRIMARY HOME CARE LIMITED LIABILITY COM",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3400 SANTA OLIVIA STE B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MISSION",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78572-8631",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3400 SANTA OLICIA STE B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MISSION",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78572-1234",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "956-458-8043",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/07/2013",
"LastUpdateDate": "03/07/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUERTA",
"AuthorizedOfficialFirstName": "GERARDO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "956-458-8043",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}