{
"Npi": {
"NPI": "1699201947",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MICHIGAN SHARE CORPORATION",
"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": "PO BOX 404",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT CLAIR SHORES",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48080-0404",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-350-0675",
"MailingAddressFaxNumber": "586-362-8334",
"FirstLinePracticeLocationAddress": "22022 OCONNOR ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT CLAIR SHORES",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48080-2043",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-350-0675",
"PracticeLocationAddressFaxNumber": "586-362-8334",
"EnumerationDate": "05/05/2017",
"LastUpdateDate": "05/05/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCMILLAN",
"AuthorizedOfficialFirstName": "ADA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PROVIDER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "586-453-8676",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": "AS500011897",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": "AS500011871",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": "AS500011889",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}