{
"Npi": {
"NPI": "1477051761",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SEA CHANGE SANTA MONICA",
"ParentOrgTIN": null,
"OrgName": "SEA CHANGE SANTA MONICA, L.P.",
"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": "1831 WILSHIRE BLVD STE C",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA MONICA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90403-5778",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "424-330-0396",
"MailingAddressFaxNumber": "323-843-9800",
"FirstLinePracticeLocationAddress": "2205 HILL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANTA MONICA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90405-5007",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "424-330-0396",
"PracticeLocationAddressFaxNumber": "323-843-9800",
"EnumerationDate": "02/01/2018",
"LastUpdateDate": "01/19/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AMES",
"AuthorizedOfficialFirstName": "ALEXXIS",
"AuthorizedOfficialMiddleName": "KYLA",
"AuthorizedOfficialTitle": "INSURANCE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "424-330-0396",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": "190831CP",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}