{
"Npi": {
"NPI": "1356611289",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RECOVERY EDGE PEER SUPPORT AND RECOVERY SERVICES, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 18",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRIEDENSBURG",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17933-0018",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-621-8533",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "18 N 2ND ST",
"SecondLinePracticeLocationAddress": "FIRST FLOOR",
"PracticeLocationAddressCityName": "POTTSVILLE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17901-2903",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-516-9094",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/10/2012",
"LastUpdateDate": "01/10/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PERHONITCH",
"AuthorizedOfficialFirstName": "EDWARD",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "CHEIF OPERATING OFFICER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "CPS/FORENSIC SPECIAL",
"AuthorizedOfficialTelephoneNumber": "570-621-8533",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "223720",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}