{
"Npi": {
"NPI": "1568655744",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SHORE UP INC",
"ParentOrgTIN": null,
"OrgName": "SHORE UP INC",
"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": "520 SNOW HILL RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALISBURY",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21804-6031",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-749-1142",
"MailingAddressFaxNumber": "410-472-9191",
"FirstLinePracticeLocationAddress": "8395 OLD WESTOVER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTOVER",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21871",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-651-4925",
"PracticeLocationAddressFaxNumber": "410-651-4928",
"EnumerationDate": "08/22/2007",
"LastUpdateDate": "08/22/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MITCHELL",
"AuthorizedOfficialFirstName": "FREDDY",
"AuthorizedOfficialMiddleName": "L.",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "410-749-1142",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": "0689",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}