{
"Npi": {
"NPI": "1437895646",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROSPERA HEALTHCARE ARKANSAS 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": "4021 W WALNUT ST # 1018",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROGERS",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72756-1842",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-900-2488",
"MailingAddressFaxNumber": "972-600-2835",
"FirstLinePracticeLocationAddress": "4021 W WALNUT ST # 1018",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROGERS",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72756-1842",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-900-2488",
"PracticeLocationAddressFaxNumber": "972-600-2835",
"EnumerationDate": "05/10/2022",
"LastUpdateDate": "05/10/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCOMAS",
"AuthorizedOfficialFirstName": "PAIGE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR OF OPERATIONS",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "972-900-2488",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103K00000X",
"TaxonomyName": "Behavior Analyst",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}