{
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"OrgName": "ADDICTION WELLNESS SERVICES INC",
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"FirstLineMailingAddress": "3824 NORTHERN PIKE STE 600",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MONROEVILLE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15146-2156",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "412-457-0175",
"MailingAddressFaxNumber": "412-457-0179",
"FirstLinePracticeLocationAddress": "5504 N 2ND ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOVES PARK",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressTelephoneNumber": "815-997-4516",
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"EnumerationDate": "11/22/2017",
"LastUpdateDate": "01/29/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOYAL",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "267-226-4760",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pediatric Anesthesiology Physician",
"LicenseNumber": "MD438154",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
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}
}
}
}