{
"Npi": {
"NPI": "1366980187",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MY PRECIOUS KIDS THERAPY CENTER INC",
"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": "190 NW 14TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOMESTEAD",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33030-4240",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "239-292-1838",
"MailingAddressFaxNumber": "239-931-6075",
"FirstLinePracticeLocationAddress": "4755 SUMMERLIN ROAD",
"SecondLinePracticeLocationAddress": "SUITE #4",
"PracticeLocationAddressCityName": "FORT MYERS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33919",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "239-292-1838",
"PracticeLocationAddressFaxNumber": "239-931-6075",
"EnumerationDate": "02/01/2017",
"LastUpdateDate": "06/08/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEBLETT",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "305-910-3247",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}