{
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"EIN": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "9778 KATELLA AVE STE 205",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANAHEIM",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92804-6447",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-413-3090",
"MailingAddressFaxNumber": "800-413-3090",
"FirstLinePracticeLocationAddress": "9778 KATELLA AVE STE 205",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANAHEIM",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-867-6979",
"PracticeLocationAddressFaxNumber": "714-333-4223",
"EnumerationDate": "10/24/2020",
"LastUpdateDate": "09/26/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JENNINGS",
"AuthorizedOfficialFirstName": "TAMARA",
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"AuthorizedOfficialTitle": "ADMINISTRATOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "800-413-3090",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251G00000X",
"TaxonomyName": "Community Based Hospice Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}