{
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"NamePrefix": null,
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"FirstLineMailingAddress": "6000 BASS LAKE RD STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CRYSTAL",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55429-2794",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-414-5055",
"MailingAddressFaxNumber": "763-746-9401",
"FirstLinePracticeLocationAddress": "6000 BASS LAKE RD STE 200",
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"PracticeLocationAddressTelephoneNumber": "612-414-5055",
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"EnumerationDate": "06/19/2012",
"LastUpdateDate": "06/19/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALSH",
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"AuthorizedOfficialTelephoneNumber": "612-414-5055",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Home Health Agency",
"LicenseNumber": "357763",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}