{
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"FirstLineMailingAddress": "54590 IRONWOOD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTH BEND",
"MailingAddressStateName": "IN",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "574-807-6170",
"MailingAddressFaxNumber": "877-235-7012",
"FirstLinePracticeLocationAddress": "54590 IRONWOOD RD",
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"PracticeLocationAddressCityName": "SOUTH BEND",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "574-968-3717",
"PracticeLocationAddressFaxNumber": "574-314-6916",
"EnumerationDate": "12/08/2014",
"LastUpdateDate": "07/21/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALMEIDA",
"AuthorizedOfficialFirstName": "ELAINE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "574-968-3717",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
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},
{
"TaxonomyCode": "3336C0003X",
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"LicenseNumberStateCode": "IN",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}