{
"Npi": {
"NPI": "1710153937",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ST NINO ADULT FAMILY HOME",
"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": "19620 8TH AVE E",
"SecondLineMailingAddress": "19724 8TH AVE E SPANAWAY WA 98387",
"MailingAddressCityName": "SPANAWAY",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98387-8478",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-875-9077",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19620 8TH AVE E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPANAWAY",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98387",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-875-9077",
"PracticeLocationAddressFaxNumber": "253-875-9077",
"EnumerationDate": "05/07/2008",
"LastUpdateDate": "05/07/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VARGAS",
"AuthorizedOfficialFirstName": "REZA",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "PROVIDER/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NAR",
"AuthorizedOfficialTelephoneNumber": "253-875-9077",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": "635100",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}