{
"Npi": {
"NPI": "1326150665",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OCTAGON REHAB SERVICES, INC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "42803 SCHOOLCRAFT RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PLYMOUTH",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48170-2697",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-542-3150",
"MailingAddressFaxNumber": "734-542-3661",
"FirstLinePracticeLocationAddress": "42803 SCHOOLCRAFT RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PLYMOUTH",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48170-2697",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-542-3150",
"PracticeLocationAddressFaxNumber": "734-542-3661",
"EnumerationDate": "08/31/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHACKO",
"AuthorizedOfficialFirstName": "BABLOO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "734-542-3150",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": "23-6822",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}