{
"Npi": {
"NPI": "1639665912",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DAMOUS CENTER",
"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": "218 D ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTH CHARLESTON",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25303-3104",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-720-3835",
"MailingAddressFaxNumber": "304-720-3836",
"FirstLinePracticeLocationAddress": "234 LEE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NITRO",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "25143",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-201-2095",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/10/2018",
"LastUpdateDate": "07/11/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAMOUS",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MA",
"AuthorizedOfficialTelephoneNumber": "304-720-3835",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}