{
"Npi": {
"NPI": "1295167625",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CAROLINA ENHANCEMENT SERVICES LLC",
"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": "2602 ERIC LN STE E1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BURLINGTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27215-5591",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-270-8005",
"MailingAddressFaxNumber": "336-270-3012",
"FirstLinePracticeLocationAddress": "2602 ERIC LN STE E1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BURLINGTON",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27215-5591",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-270-8005",
"PracticeLocationAddressFaxNumber": "336-270-3012",
"EnumerationDate": "08/08/2013",
"LastUpdateDate": "01/08/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FUNCHESS",
"AuthorizedOfficialFirstName": "ADRIAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "B.S.",
"AuthorizedOfficialTelephoneNumber": "336-501-8643",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251C00000X",
"TaxonomyName": "Developmentally Disabled Services Day Training Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}