{
"Npi": {
"NPI": "1649504036",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AMERISA, INC.",
"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": "313 N. LEE",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "HEREFORD",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79045-7904",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "806-336-6554",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "313 N. LEE",
"SecondLinePracticeLocationAddress": "SUTIE B",
"PracticeLocationAddressCityName": "HEREFORD",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79045-7904",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "806-591-0016",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/01/2009",
"LastUpdateDate": "11/02/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PUENTE",
"AuthorizedOfficialFirstName": "ROY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO/PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "806-591-0016",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "67-2080",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}