{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"LastName": null,
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"NamePrefix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "113 W BROADWAY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MISSOULA",
"MailingAddressStateName": "MT",
"MailingAddressPostalCode": "59802-4217",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "406-884-2006",
"MailingAddressFaxNumber": "406-884-2009",
"FirstLinePracticeLocationAddress": "113 W BROADWAY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MISSOULA",
"PracticeLocationAddressStateName": "MT",
"PracticeLocationAddressPostalCode": "59802-4217",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "406-884-2006",
"PracticeLocationAddressFaxNumber": "406-884-2009",
"EnumerationDate": "04/24/2017",
"LastUpdateDate": "04/24/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WINTER",
"AuthorizedOfficialFirstName": "DANIEL",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "406-884-2006",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}