{
"Npi": {
"NPI": "1598262057",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCE CARE AND REHAB",
"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": "2555 SUFFIELD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DES PLAINES",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60016-4831",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "224-595-1631",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2555 SUFFIELD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DES PLAINES",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60016-4831",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "224-595-1631",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/11/2018",
"LastUpdateDate": "04/11/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAMSUDDIN",
"AuthorizedOfficialFirstName": "ABDUL",
"AuthorizedOfficialMiddleName": "MANNAN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "224-595-1631",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "070023234",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}