{
"Npi": {
"NPI": "1649589623",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "THE SALVATION ARMY",
"ParentOrgTIN": null,
"OrgName": "SAGE HOUSE ADULT DAY CARE CENTER",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "138 S BANDINI ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN PEDRO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90731-2321",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-832-6031",
"MailingAddressFaxNumber": "310-832-6677",
"FirstLinePracticeLocationAddress": "138 S BANDINI ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN PEDRO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90731-2321",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-832-6031",
"PracticeLocationAddressFaxNumber": "310-832-6677",
"EnumerationDate": "09/24/2010",
"LastUpdateDate": "09/24/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARDIN",
"AuthorizedOfficialFirstName": "GERALD",
"AuthorizedOfficialMiddleName": "LEWIS",
"AuthorizedOfficialTitle": "EXEC. DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BSM",
"AuthorizedOfficialTelephoneNumber": "310-832-6031",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": "198600603",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}