{
"Npi": {
"NPI": "1336189166",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ALPHA BRIDGE HOME HEALTH, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1543 LAKELAND HILLS BLVD",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "LAKELAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33805-3246",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-937-8370",
"MailingAddressFaxNumber": "863-937-8398",
"FirstLinePracticeLocationAddress": "1543 LAKELAND HILLS BLVD",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "LAKELAND",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33805-3246",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-937-8370",
"PracticeLocationAddressFaxNumber": "863-937-8398",
"EnumerationDate": "06/08/2006",
"LastUpdateDate": "02/27/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOOD",
"AuthorizedOfficialFirstName": "DELBERT",
"AuthorizedOfficialMiddleName": "SCOTT",
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "813-397-4101",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "299992370",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}