{
"Npi": {
"NPI": "1700176732",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KESHA HEALTH CARE SERVICE,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": "135 MANSEAU DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINTER HAVEN",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33880-1719",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-595-6212",
"MailingAddressFaxNumber": "863-875-4742",
"FirstLinePracticeLocationAddress": "135 MANSEAU DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WINTER HAVEN",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33880-1719",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-595-6212",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/11/2011",
"LastUpdateDate": "04/11/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YOUNG",
"AuthorizedOfficialFirstName": "NAKESHA",
"AuthorizedOfficialMiddleName": "SHONEASE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "863-595-6212",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "001447200",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}