{
"Npi": {
"NPI": "1619102407",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHEAST HOMECARE LLC",
"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": "1200 NW 17 AVENUE",
"SecondLineMailingAddress": "SUITE 10",
"MailingAddressCityName": "DELRAY BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33445",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-819-6400",
"MailingAddressFaxNumber": "561-819-6401",
"FirstLinePracticeLocationAddress": "1200 NW 17TH AVE STE 10",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DELRAY BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33445-2512",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-819-6400",
"PracticeLocationAddressFaxNumber": "561-819-6401",
"EnumerationDate": "05/21/2009",
"LastUpdateDate": "09/18/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MENDEZ",
"AuthorizedOfficialFirstName": "LINDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF OPERATING OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "844-215-4264",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "HHA299992181",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}