{
"Npi": {
"NPI": "1487123451",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HEALING WATERS OUTREACH MINISTRIES",
"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": "1547 GENESEE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BUFFALO",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14211-1632",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-725-0561",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1547 GENESEE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BUFFALO",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14211-1632",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-725-0561",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/19/2018",
"LastUpdateDate": "11/19/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOWELL-ISRAEL",
"AuthorizedOfficialFirstName": "BENITA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGING DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CERT.RECOVERY COACH",
"AuthorizedOfficialTelephoneNumber": "160-717-6839",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "177F00000X",
"TaxonomyName": "Lodging Provider",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251300000X",
"TaxonomyName": "Local Education Agency (LEA)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "305S00000X",
"TaxonomyName": "Point of Service",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}