{
"Npi": {
"NPI": "1598869158",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MENNONITE MEMORIAL HOME",
"ParentOrgTIN": null,
"OrgName": "MENNONITE MEMORIAL HOME",
"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": "410 W. ELM ST.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLUFFTON",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45817",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-358-7803",
"MailingAddressFaxNumber": "419-358-4269",
"FirstLinePracticeLocationAddress": "410 W ELM ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLUFFTON",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45817-1122",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-358-7803",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/12/2006",
"LastUpdateDate": "08/19/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEE",
"AuthorizedOfficialFirstName": "DAREN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "419-358-7803",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "36-7650",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}