{
"Npi": {
"NPI": "1669903852",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MODESTO ADULT DAY PROGRAM PARTNERS",
"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": "3217 TULLY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MODESTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95350-0832",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-622-0963",
"MailingAddressFaxNumber": "209-661-4903",
"FirstLinePracticeLocationAddress": "3217 TULLY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MODESTO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95350-0832",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-622-0963",
"PracticeLocationAddressFaxNumber": "209-661-4903",
"EnumerationDate": "03/21/2017",
"LastUpdateDate": "03/21/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILNES",
"AuthorizedOfficialFirstName": "RUSSELL",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "GENERAL PARTNER/ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "209-622-0963",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": "502700147",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}