{
"Npi": {
"NPI": "1689427130",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EMBERS TO BLOOM LLC",
"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": "9300 CONROY WINDERMERE RD UNIT 3089",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINDERMERE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34786-5121",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "321-895-2676",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "159 CROCKER PARK BLVD STE 400",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTLAKE",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44145-8147",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "513-513-6237",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/05/2024",
"LastUpdateDate": "09/05/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEMESMIN",
"AuthorizedOfficialFirstName": "NICHOLE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGING MEMBER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "407-230-3954",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}