{
"Npi": {
"NPI": "1427171933",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INDIVIDUAL SUPPORT SERVICES",
"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": "7665 N RAIDER RD",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "MIDDLETOWN",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47356-9401",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "765-354-9009",
"MailingAddressFaxNumber": "765-354-9090",
"FirstLinePracticeLocationAddress": "7665 N RAIDER RD",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "MIDDLETOWN",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "47356-9401",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "765-354-9009",
"PracticeLocationAddressFaxNumber": "765-354-9090",
"EnumerationDate": "04/09/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOORE",
"AuthorizedOfficialFirstName": "KIMBERLY",
"AuthorizedOfficialMiddleName": "JO",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "765-354-9009",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "011160",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}