{
"Npi": {
"NPI": "1619414232",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FREEDOM BEHAVIORAL HEALTHCARE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1000 GERMANTOWN PIKE",
"SecondLineMailingAddress": "BLDG G-5",
"MailingAddressCityName": "PLYMOUTH MEETING",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19462-2480",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-941-3390",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4612 E STREET RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TREVOSE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19053-6612",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "267-699-3000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/20/2017",
"LastUpdateDate": "01/20/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FABIANI",
"AuthorizedOfficialFirstName": "CESAR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SUBOXONE MAINTENANCE DOCTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "126-769-9300",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}