{
"Npi": {
"NPI": "1669965349",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PETIT AVE 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": "6719 QUAKERTOWN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINNETKA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91306-4336",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-945-4374",
"MailingAddressFaxNumber": "818-435-3079",
"FirstLinePracticeLocationAddress": "6719 QUAKERTOWN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WINNETKA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91306-4336",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-945-4374",
"PracticeLocationAddressFaxNumber": "818-435-3079",
"EnumerationDate": "06/07/2018",
"LastUpdateDate": "06/25/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GHAZARYAN",
"AuthorizedOfficialFirstName": "EDGAR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RRT, RCP",
"AuthorizedOfficialTelephoneNumber": "818-945-4374",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}