{
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"FirstLineMailingAddress": "1325 S 123RD DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AVONDALE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85323-3140",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "602-399-2610",
"MailingAddressFaxNumber": "480-718-8633",
"FirstLinePracticeLocationAddress": "3101 N CENTRAL AVE STE 770",
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"PracticeLocationAddressCityName": "PHOENIX",
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"PracticeLocationAddressTelephoneNumber": "602-399-2610",
"PracticeLocationAddressFaxNumber": "480-718-8633",
"EnumerationDate": "09/23/2020",
"LastUpdateDate": "02/27/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIOZON",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "602-399-2610",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}