{
"Npi": {
"NPI": "1699874412",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OUR HOUSE RESIDENTIAL CARE, INC",
"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": "500 S D ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MADERA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93638-3857",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "559-673-1922",
"MailingAddressFaxNumber": "559-673-4825",
"FirstLinePracticeLocationAddress": "109 E CENTRAL AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MADERA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93638-3109",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "559-674-8670",
"PracticeLocationAddressFaxNumber": "559-673-4825",
"EnumerationDate": "09/21/2006",
"LastUpdateDate": "01/25/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LENNEMANN",
"AuthorizedOfficialFirstName": "DANA",
"AuthorizedOfficialMiddleName": "DAWN",
"AuthorizedOfficialTitle": "VICE PRESIDENT OF OPERATIONS",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "559-674-8670",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "315P00000X",
"TaxonomyName": "Intellectual Disabilities Intermediate Care Facility",
"LicenseNumber": "LTC80042F",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "315P00000X",
"TaxonomyName": "Intellectual Disabilities Intermediate Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}