{
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"EIN": null,
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"ParentOrgTIN": null,
"OrgName": "SAN FERNANDO MISSION GROUP HOME",
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"NamePrefix": null,
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"FirstLineMailingAddress": "22455 VICTORY BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST HILLS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91307",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-592-2960",
"MailingAddressFaxNumber": "818-592-2961",
"FirstLinePracticeLocationAddress": "17157 SAN FERNANDO MISSION BLVD.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRANADA HILLS",
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"PracticeLocationAddressPostalCode": "91344",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-488-9046",
"PracticeLocationAddressFaxNumber": "818-488-9046",
"EnumerationDate": "09/01/2016",
"LastUpdateDate": "09/01/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARQUEZ",
"AuthorizedOfficialFirstName": "JORGE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "818-592-2960",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "322D00000X",
"TaxonomyName": "Emotionally Disturbed Childrens' Residential Treatment Facility",
"LicenseNumber": "198208017",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}