{
"Npi": {
"NPI": "1730032244",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HUMAN SERVICES BOARD SERVING NORTH CENTRAL HEALTH CARE",
"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": "1225 LANGLADE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANTIGO",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54409-2762",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-347-2110",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1225 LANGLADE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANTIGO",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54409-2762",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "715-347-2110",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/16/2026",
"LastUpdateDate": "02/16/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHULIST",
"AuthorizedOfficialFirstName": "AMANDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CERTIFIED CREDENTIALING SPECIALIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "715-848-4457",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}