{
"Npi": {
"NPI": "1659090595",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PREMIUM PERSONAL HOME CARE LLC",
"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": "3801 N COUNTY ROAD 1140",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDLAND",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79705-9609",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "432-270-6074",
"MailingAddressFaxNumber": "432-260-6077",
"FirstLinePracticeLocationAddress": "3801 N COUNTY ROAD 1140",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIDLAND",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79705-9609",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "432-270-6074",
"PracticeLocationAddressFaxNumber": "432-260-6077",
"EnumerationDate": "08/24/2022",
"LastUpdateDate": "09/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAGO",
"AuthorizedOfficialFirstName": "OSLEIDIS",
"AuthorizedOfficialMiddleName": "PEREZ",
"AuthorizedOfficialTitle": "MEDICAL ASSISTANT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "432-556-7841",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}