{
"Npi": {
"NPI": "1487120143",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "REMEDIES RENEWING LIVES",
"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": "220 EASTON PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROCKFORD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61108-2203",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-966-1285",
"MailingAddressFaxNumber": "815-962-7895",
"FirstLinePracticeLocationAddress": "1908 PIERCE CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BELVIDERE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61008-1742",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-547-4502",
"PracticeLocationAddressFaxNumber": "815-544-0391",
"EnumerationDate": "10/22/2018",
"LastUpdateDate": "10/22/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRANNING",
"AuthorizedOfficialFirstName": "KATHY",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "VP OF MARKETING/FUND DEVELOPMENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.S., LCPC, CADC,",
"AuthorizedOfficialTelephoneNumber": "815-966-1285",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}