{
"Npi": {
"NPI": "1679110506",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DAVID HERZKA",
"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": "516 SHADY OAKS TRL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BURLESON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76028-2320",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-933-5432",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "12411 GAYTON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RICHMOND",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23238-2272",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-741-9494",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/10/2019",
"LastUpdateDate": "12/10/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KING",
"AuthorizedOfficialFirstName": "JULIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BILLING SUPERVISOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "817-933-7582",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}