{
"Npi": {
"NPI": "1659417624",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PCGH, 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": "P O BOX 721",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROXBORO",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27573-0721",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-599-9421",
"MailingAddressFaxNumber": "366-599-7220",
"FirstLinePracticeLocationAddress": "202 N MAIN STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROXBORO",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27573-0721",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-599-9421",
"PracticeLocationAddressFaxNumber": "336-599-7220",
"EnumerationDate": "01/29/2007",
"LastUpdateDate": "07/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAY",
"AuthorizedOfficialFirstName": "MELISSA",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "CLINICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "336-599-9421",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251C00000X",
"TaxonomyName": "Developmentally Disabled Services Day Training Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "251X00000X",
"TaxonomyName": "Supports Brokerage Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "315P00000X",
"TaxonomyName": "Intellectual Disabilities Intermediate Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}