{
"Npi": {
"NPI": "1326550435",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VALLEY OPTIMAL HEALTH, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 380",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HADLEY",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01035-0380",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "413-582-1839",
"MailingAddressFaxNumber": "413-582-6855",
"FirstLinePracticeLocationAddress": "8 RIVER DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HADLEY",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "01035-3540",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "413-582-1839",
"PracticeLocationAddressFaxNumber": "413-582-6855",
"EnumerationDate": "10/30/2017",
"LastUpdateDate": "02/15/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GODEREZ",
"AuthorizedOfficialFirstName": "BRUCE",
"AuthorizedOfficialMiddleName": "I",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "413-582-1839",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "50762",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}