{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "GROWTH HOME HEALTH CARE LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15064 CARROLLTON BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARROLLTON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23314-3582",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-774-8941",
"MailingAddressFaxNumber": "757-299-4801",
"FirstLinePracticeLocationAddress": "15064 CARROLLTON BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CARROLLTON",
"PracticeLocationAddressStateName": "VA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-774-8941",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/09/2018",
"LastUpdateDate": "08/19/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAY",
"AuthorizedOfficialFirstName": "RONNIE",
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"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "757-774-8941",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}