{
"Npi": {
"NPI": "1710223631",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MERCURY HOME HEALTH SERVICES 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": "1241 S GLENDALE AVE,",
"SecondLineMailingAddress": "STE 305-D",
"MailingAddressCityName": "GLENDALE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91205-3204",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-925-6475",
"MailingAddressFaxNumber": "818-459-6975",
"FirstLinePracticeLocationAddress": "2829 N GLENOAKS BLVD STE 104",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BURBANK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91504-2660",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "747-241-8593",
"PracticeLocationAddressFaxNumber": "747-241-8596",
"EnumerationDate": "12/20/2012",
"LastUpdateDate": "03/25/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALAVERDYAN",
"AuthorizedOfficialFirstName": "SAMUEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "747-241-8593",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "550002600",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}