{
"Npi": {
"NPI": "1619072915",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SAN VICENTE HOME HEALTH 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": "PO BOX 2307",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SILVER CITY",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "88062-2307",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-538-0912",
"MailingAddressFaxNumber": "505-538-0917",
"FirstLinePracticeLocationAddress": "200 N ARIZONA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SILVER CITY",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "88061-4963",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-538-0912",
"PracticeLocationAddressFaxNumber": "505-538-0917",
"EnumerationDate": "09/13/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GONZALES",
"AuthorizedOfficialFirstName": "MISTY",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "505-538-0912",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "6549",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}