{
"Npi": {
"NPI": "1619223062",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GREENLEAF MANAGEMENT",
"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": "4707 GREENLEAF CT",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "MODESTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95356-8733",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-338-1550",
"MailingAddressFaxNumber": "209-545-2404",
"FirstLinePracticeLocationAddress": "4707 GREENLEAF CT",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "MODESTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95356-8733",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-338-1550",
"PracticeLocationAddressFaxNumber": "209-545-2404",
"EnumerationDate": "08/02/2012",
"LastUpdateDate": "06/16/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DANIELS",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "209-338-1510",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": "G29874",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}