{
"Npi": {
"NPI": "1700336211",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUPREME HOSPICE INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "28312 CONSTELLATION RD",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "VALENCIA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91355-5078",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "661-388-4328",
"MailingAddressFaxNumber": "661-402-2337",
"FirstLinePracticeLocationAddress": "28312 CONSTELLATION RD",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "VALENCIA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91355-5078",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "661-388-4328",
"PracticeLocationAddressFaxNumber": "661-402-2337",
"EnumerationDate": "10/07/2016",
"LastUpdateDate": "03/24/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROMERO",
"AuthorizedOfficialFirstName": "CAROLYN",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "ADMINSTRATOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BSN, RN",
"AuthorizedOfficialTelephoneNumber": "818-268-8813",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251G00000X",
"TaxonomyName": "Community Based Hospice Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}