{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5230 CLARK AVE STE 19",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKEWOOD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90712-2674",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-278-2466",
"MailingAddressFaxNumber": "562-278-2466",
"FirstLinePracticeLocationAddress": "5230 CLARK AVE STE 19",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKEWOOD",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-278-2466",
"PracticeLocationAddressFaxNumber": "562-278-2466",
"EnumerationDate": "02/19/2022",
"LastUpdateDate": "02/19/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "QUIBAL",
"AuthorizedOfficialFirstName": "MICHAEL",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "562-278-2466",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}