{
"Npi": {
"NPI": "1689840050",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EVERGREENHEALTH AND REHAB",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7680 VINEYARDS LN NE APT K302",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BREMERTON",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98311-9255",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "360-689-5673",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3517 11TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BREMERTON",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98312-2633",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-475-0745",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/05/2008",
"LastUpdateDate": "05/05/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KULFAN",
"AuthorizedOfficialFirstName": "THOMAS",
"AuthorizedOfficialMiddleName": "GERARD",
"AuthorizedOfficialTitle": "CERTIFIED OCCUPATIONAL THERAPY ASSI",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "COTA",
"AuthorizedOfficialTelephoneNumber": "360-689-5673",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "OC00001206",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}