{
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"FirstLineMailingAddress": "PO BOX 745",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11115 CHICKEN DINNER RD",
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"PracticeLocationAddressCityName": "CALDWELL",
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"EnumerationDate": "09/30/2025",
"LastUpdateDate": "09/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COOKE",
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"AuthorizedOfficialTelephoneNumber": "208-250-9963",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Lodging Provider",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}