{
"Npi": {
"NPI": "1558321901",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROFESSIONAL HEALTHCARE AT HOME LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6330 SPRINT PKWY STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OVERLAND PARK",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "66211-1157",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "913-814-2674",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "395 TAYLOR BLVD",
"SecondLinePracticeLocationAddress": "SUITE 118",
"PracticeLocationAddressCityName": "PLEASANT HILL",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94523-2286",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "925-246-6000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/27/2006",
"LastUpdateDate": "09/01/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NICHOLS",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "AUTHORIZED SIGNATORY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "925-246-6000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "020000449",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}