{
"Npi": {
"NPI": "1609954668",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MJM HEALTH 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": "12807 FALCON CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LEMONT",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60439-7300",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "773-643-0227",
"MailingAddressFaxNumber": "773-643-0227",
"FirstLinePracticeLocationAddress": "5517 SOUTH MICHIGAN STREET",
"SecondLinePracticeLocationAddress": "LOWER LEVEL",
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60615",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "773-643-0227",
"PracticeLocationAddressFaxNumber": "773-643-0227",
"EnumerationDate": "11/01/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANDU-ALAUSA",
"AuthorizedOfficialFirstName": "KEMI",
"AuthorizedOfficialMiddleName": "ASSISAT",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPA, MBA",
"AuthorizedOfficialTelephoneNumber": "630-670-6416",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "1765224",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}