{
"Npi": {
"NPI": "1295177269",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EUREKA MENTAL HEALTH & WELLNES 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": "PO BOX 30500",
"SecondLineMailingAddress": "PMB 247",
"MailingAddressCityName": "MANATI",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00674",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-427-4722",
"MailingAddressFaxNumber": "787-854-0650",
"FirstLinePracticeLocationAddress": "PR-4494 KM 2.6",
"SecondLinePracticeLocationAddress": "PLAZA CAMUY BUILDING",
"PracticeLocationAddressCityName": "CAMUY",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00627",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-427-4722",
"PracticeLocationAddressFaxNumber": "787-854-0650",
"EnumerationDate": "07/19/2013",
"LastUpdateDate": "07/19/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEDINA",
"AuthorizedOfficialFirstName": "SONIA",
"AuthorizedOfficialMiddleName": "MARIA",
"AuthorizedOfficialTitle": "DHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "787-427-4722",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QM0855X",
"TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
"LicenseNumber": "005177",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "005177",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}