{
"Npi": {
"NPI": "1336355783",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EAGLE CREST LIFE SERVICES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 3723",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COEUR D ALENE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83816-2529",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-666-9162",
"MailingAddressFaxNumber": "208-769-9321",
"FirstLinePracticeLocationAddress": "212 S 11TH ST",
"SecondLinePracticeLocationAddress": "STE. 3",
"PracticeLocationAddressCityName": "COEUR D ALENE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83814-4000",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-666-9162",
"PracticeLocationAddressFaxNumber": "208-769-9321",
"EnumerationDate": "05/15/2007",
"LastUpdateDate": "03/13/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHEELER",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BA",
"AuthorizedOfficialTelephoneNumber": "208-666-9162",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}