{
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"FirstLineMailingAddress": "24080 SENECA STREET",
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"MailingAddressCityName": "OAK PARK",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48237",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "24080 SENECA ST",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/07/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATTOX",
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"AuthorizedOfficialCredential": "R.N.",
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"Taxonomies": {
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"TaxonomyName": "Psychiatric Hospital",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}