{
"Npi": {
"NPI": "1447697131",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "HAVEN CARE LLC",
"ParentOrgTIN": null,
"OrgName": "HAVEN 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": "11669 KADES TRL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAMPTON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30228-4010",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-218-5735",
"MailingAddressFaxNumber": "770-703-1532",
"FirstLinePracticeLocationAddress": "11669 KADES TRL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAMPTON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30228-4010",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-218-5735",
"PracticeLocationAddressFaxNumber": "770-703-1532",
"EnumerationDate": "06/04/2013",
"LastUpdateDate": "06/04/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOODDINE",
"AuthorizedOfficialFirstName": "SHERRY",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "404-218-5735",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "320800000X",
"TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
"LicenseNumber": "PCH006808",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}