{
"Npi": {
"NPI": "1598992752",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEW LIFE HEALTHCARE AGENCY, INC",
"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": "5209 YORK RD",
"SecondLineMailingAddress": "SUITE M-16, MAIL BOX B-16",
"MailingAddressCityName": "BALTIMORE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21212-4225",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-323-5433",
"MailingAddressFaxNumber": "410-435-5433",
"FirstLinePracticeLocationAddress": "5209 YORK RD",
"SecondLinePracticeLocationAddress": "SUITE M-16, MAIL BOX B-16",
"PracticeLocationAddressCityName": "BALTIMORE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21212-4225",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-323-5433",
"PracticeLocationAddressFaxNumber": "410-435-5433",
"EnumerationDate": "06/16/2009",
"LastUpdateDate": "11/18/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROBERTS",
"AuthorizedOfficialFirstName": "BRIGGS",
"AuthorizedOfficialMiddleName": "MAXWELL",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BA",
"AuthorizedOfficialTelephoneNumber": "410-323-5433",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "R2768P",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}