{
"Npi": {
"NPI": "1710081385",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RICHMOND STATE HOSPITAL",
"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": "498 NW 18TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHMOND",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47374-2851",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "765-966-0511",
"MailingAddressFaxNumber": "765-935-9503",
"FirstLinePracticeLocationAddress": "498 NW 18TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RICHMOND",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "47374-2851",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "765-966-0511",
"PracticeLocationAddressFaxNumber": "765-935-9503",
"EnumerationDate": "09/12/2006",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VILLARIN",
"AuthorizedOfficialFirstName": "ADRIAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "765-966-0511",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "320600000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
"LicenseNumber": "01021356",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}