{
"Npi": {
"NPI": "1306299805",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAITRI COMMUNITY SERVICES",
"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": "3709 N LOCUST GROVE RD",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "MERIDIAN",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83646-6449",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-957-5360",
"MailingAddressFaxNumber": "208-493-4331",
"FirstLinePracticeLocationAddress": "3709 N LOCUST GROVE RD",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "MERIDIAN",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83646-6449",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-957-5360",
"PracticeLocationAddressFaxNumber": "208-493-4331",
"EnumerationDate": "07/20/2016",
"LastUpdateDate": "07/20/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EATON",
"AuthorizedOfficialFirstName": "LORI",
"AuthorizedOfficialMiddleName": "NICOLE",
"AuthorizedOfficialTitle": "OWNER/PROVIDER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "208-957-5360",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "31259",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}