{
"Npi": {
"NPI": "1649344821",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HENRY LEE WILLIS COMMUNITY CENTER, 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": "119 FOREST ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WORCESTER",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01609-1529",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "508-799-0702",
"MailingAddressFaxNumber": "508-754-0245",
"FirstLinePracticeLocationAddress": "44 FRONT ST",
"SecondLinePracticeLocationAddress": "SUITE 480",
"PracticeLocationAddressCityName": "WORCESTER",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "01608-1733",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "508-799-2934",
"PracticeLocationAddressFaxNumber": "508-770-1732",
"EnumerationDate": "11/20/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WATSON",
"AuthorizedOfficialFirstName": "CARLTON",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "508-799-0702",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "0690",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}