{
"Npi": {
"NPI": "1649449091",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "FAITH HOME, INC.",
"ParentOrgTIN": null,
"OrgName": "FAITH HOME, 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": "2501 DONLORA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREENSBORO",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27407-6015",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-854-1718",
"MailingAddressFaxNumber": "336-854-1718",
"FirstLinePracticeLocationAddress": "808 MYSTIC DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENSBORO",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27406-5726",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-856-0671",
"PracticeLocationAddressFaxNumber": "336-856-0671",
"EnumerationDate": "02/29/2008",
"LastUpdateDate": "04/07/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STURDIVANT",
"AuthorizedOfficialFirstName": "LEON",
"AuthorizedOfficialMiddleName": "HARLIE",
"AuthorizedOfficialTitle": "OWNER / DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "SR.",
"AuthorizedOfficialCredential": "DIRECT OWNER (DO)",
"AuthorizedOfficialTelephoneNumber": "336-854-1718",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "322D00000X",
"TaxonomyName": "Emotionally Disturbed Childrens' Residential Treatment Facility",
"LicenseNumber": "MHL041732",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}