{
"Npi": {
"NPI": "1619580669",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIFELINE COMMUNITY SUPPORT, 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": "1666 79TH STREET CSWY STE 603",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH BAY VILLAGE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33141-4190",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "786-518-8931",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1666 79TH STREET CSWY STE 603",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH BAY VILLAGE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33141-4190",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "178-651-8893",
"PracticeLocationAddressFaxNumber": "786-254-7303",
"EnumerationDate": "08/28/2020",
"LastUpdateDate": "08/18/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VILLATORO",
"AuthorizedOfficialFirstName": "SERGIO",
"AuthorizedOfficialMiddleName": "ALEJANDRO",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BHCM",
"AuthorizedOfficialTelephoneNumber": "786-518-8931",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251B00000X",
"TaxonomyName": "Case Management Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}