{
"Npi": {
"NPI": "1629056577",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PETRA HEALTH, INC.",
"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": "10010 SAN PEDRO AVE",
"SecondLineMailingAddress": "STE 120",
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78216-3862",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-495-5493",
"MailingAddressFaxNumber": "210-491-4331",
"FirstLinePracticeLocationAddress": "10010 SAN PEDRO AVE",
"SecondLinePracticeLocationAddress": "STE 120",
"PracticeLocationAddressCityName": "SAN ANTONIO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78216-3862",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "210-495-5493",
"PracticeLocationAddressFaxNumber": "210-491-4331",
"EnumerationDate": "01/02/2006",
"LastUpdateDate": "12/17/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MORTAZAVI",
"AuthorizedOfficialFirstName": "AMIR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "210-495-5493",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "013766",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}