{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "ST. PAUL'S HOME CARE III",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4910 KOENIG RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RENO",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89506-7811",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "775-657-6483",
"MailingAddressFaxNumber": "775-453-2263",
"FirstLinePracticeLocationAddress": "4910 KOENIG ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RENO",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89506-7811",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "775-657-6483",
"PracticeLocationAddressFaxNumber": "775-453-2263",
"EnumerationDate": "06/30/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BELTEJAR",
"AuthorizedOfficialFirstName": "JERIS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "775-657-6483",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "7195-AGC-6",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}