{
"Npi": {
"NPI": "1366690679",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ST. CAMILLUS HEALTH CENTER, INC.",
"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": "10101 W WISCONSIN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAUWATOSA",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53226-4861",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-258-2418",
"MailingAddressFaxNumber": "414-259-4534",
"FirstLinePracticeLocationAddress": "10101 W WISCONSIN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WAUWATOSA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53226-4861",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "414-258-2418",
"PracticeLocationAddressFaxNumber": "414-259-4534",
"EnumerationDate": "08/29/2008",
"LastUpdateDate": "12/05/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ONDREJICKA",
"AuthorizedOfficialFirstName": "ANN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BSW",
"AuthorizedOfficialTelephoneNumber": "414-258-2418",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251G00000X",
"TaxonomyName": "Community Based Hospice Care Agency",
"LicenseNumber": "2026",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}