{
"Npi": {
"NPI": "1659532950",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PEDI-CARE, 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": "17048 PATRICIA ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PAYNESVILLE",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "56362-9725",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-345-0207",
"MailingAddressFaxNumber": "320-453-3579",
"FirstLinePracticeLocationAddress": "17048 PATRICIA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PAYNESVILLE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "56362-9725",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "612-356-0207",
"PracticeLocationAddressFaxNumber": "320-453-3579",
"EnumerationDate": "06/19/2008",
"LastUpdateDate": "02/19/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RYAN",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "612-356-0207",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "340159",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}