{
"Npi": {
"NPI": "1386292779",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MINDFUL LIVING & CARE, LLC",
"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": "1147 BROOKFOREST AVE # 252",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHOREWOOD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60404-8845",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-299-0956",
"MailingAddressFaxNumber": "815-265-6615",
"FirstLinePracticeLocationAddress": "8204 COOP AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JOLIET",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60431-5400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-299-0956",
"PracticeLocationAddressFaxNumber": "815-265-6615",
"EnumerationDate": "08/28/2019",
"LastUpdateDate": "08/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOELZ",
"AuthorizedOfficialFirstName": "MELISSA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "708-299-0956",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251V00000X",
"TaxonomyName": "Voluntary or Charitable Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "347C00000X",
"TaxonomyName": "Private Vehicle",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "385H00000X",
"TaxonomyName": "Respite Care",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "385HR2055X",
"TaxonomyName": "Child Mental Illness Respite Care",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "385HR2060X",
"TaxonomyName": "Child Intellectual and/or Developmental Disabilities Respite Care",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "385HR2065X",
"TaxonomyName": "Child Physical Disabilities Respite Care",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}