{
"Npi": {
"NPI": "1386627818",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BOLTON HEALTHCARE, LLC",
"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": "PO BOX 841",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELKHART",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75839-0841",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-764-0033",
"MailingAddressFaxNumber": "903-764-1556",
"FirstLinePracticeLocationAddress": "1300 S FRAZIER ST",
"SecondLinePracticeLocationAddress": "SUITE 205",
"PracticeLocationAddressCityName": "CONROE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77301-4400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "936-828-3739",
"PracticeLocationAddressFaxNumber": "936-828-3741",
"EnumerationDate": "11/29/2005",
"LastUpdateDate": "06/04/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOLTON",
"AuthorizedOfficialFirstName": "ROY",
"AuthorizedOfficialMiddleName": "H.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "903-764-0033",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": "1810244-03",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "012073",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}