{
"Npi": {
"NPI": "1497073241",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE YOUTH CAMPUS",
"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": "733 N PROSPECT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PARK RIDGE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60068-2764",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-823-5161",
"MailingAddressFaxNumber": "847-823-9291",
"FirstLinePracticeLocationAddress": "901 W JACKSON BLVD",
"SecondLinePracticeLocationAddress": "5TH FLOOR",
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60607-3023",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "312-243-0533",
"PracticeLocationAddressFaxNumber": "312-243-7610",
"EnumerationDate": "05/04/2010",
"LastUpdateDate": "05/04/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUIDI",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PSY.D., CADC",
"AuthorizedOfficialTelephoneNumber": "847-823-5161",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "253J00000X",
"TaxonomyName": "Foster Care Agency",
"LicenseNumber": "141828",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}