{
"Npi": {
"NPI": "1609309798",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHERN ROOTS IN-HOME CARE LLC",
"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": "301 S BENTON ST MH",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SIKESTON",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63801-0301",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-667-0028",
"MailingAddressFaxNumber": "573-667-0028",
"FirstLinePracticeLocationAddress": "301 S BENTON ST MH",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MOREHOUSE",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63868-0301",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-667-0028",
"PracticeLocationAddressFaxNumber": "573-667-0028",
"EnumerationDate": "04/06/2017",
"LastUpdateDate": "04/06/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SQUIRES",
"AuthorizedOfficialFirstName": "BARBARA",
"AuthorizedOfficialMiddleName": "LYNN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "573-703-2229",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "985864",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}