{
"Npi": {
"NPI": "1568503282",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COASTSIDE ADULT DAY HEALTH CENTER",
"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": "645 CORREAS ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HALF MOON BAY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94019-1962",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "650-726-5067",
"MailingAddressFaxNumber": "650-726-8743",
"FirstLinePracticeLocationAddress": "645 CORREAS ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HALF MOON BAY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94019-1962",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "650-726-5067",
"PracticeLocationAddressFaxNumber": "650-726-8743",
"EnumerationDate": "02/08/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BONO",
"AuthorizedOfficialFirstName": "JANIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.N.",
"AuthorizedOfficialTelephoneNumber": "650-726-5067",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}