{
"Npi": {
"NPI": "1558812461",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "HOLY ANGELS INC.",
"ParentOrgTIN": null,
"OrgName": "LIFECHOICES",
"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": "225B MARKET ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CRAMERTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28032-1146",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6600 W WILKINSON BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BELMONT",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28012-2796",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-825-4161",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/17/2016",
"LastUpdateDate": "10/17/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOODY",
"AuthorizedOfficialFirstName": "REGINA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "704-825-4161",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251C00000X",
"TaxonomyName": "Developmentally Disabled Services Day Training Agency",
"LicenseNumber": "036-310",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}