{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "805 ANGELS LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5565 CARPINTERIA AVE",
"SecondLineMailingAddress": "STE 1",
"MailingAddressCityName": "CARPINTERIA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93013",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "805-284-0221",
"MailingAddressFaxNumber": "805-284-0223",
"FirstLinePracticeLocationAddress": "5565 CARPINTERIA AVE",
"SecondLinePracticeLocationAddress": "STE 1",
"PracticeLocationAddressCityName": "CARPINTERIA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93013",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "805-284-0221",
"PracticeLocationAddressFaxNumber": "805-284-0223",
"EnumerationDate": "06/07/2018",
"LastUpdateDate": "06/07/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TULLY-ROOS",
"AuthorizedOfficialFirstName": "LYDIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD",
"AuthorizedOfficialTelephoneNumber": "805-284-0221",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3747P1801X",
"TaxonomyName": "Personal Care Attendant",
"LicenseNumber": "4247000Z0",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}