{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "DIRECT PROVIDER OF HEALTHCARE SERVICES, INC",
"ParentOrgTIN": null,
"OrgName": "DIRECT PROVIDER OF HOSPICE, INC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9320 BASELINE RD",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "RANCHO CUCAMONGA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91701-5829",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-319-0635",
"MailingAddressFaxNumber": "909-944-3878",
"FirstLinePracticeLocationAddress": "6671 VIANZA PLACE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RANCHO CUCAMONGA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-319-0635",
"PracticeLocationAddressFaxNumber": "909-319-0635",
"EnumerationDate": "05/20/2013",
"LastUpdateDate": "05/20/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIEGO",
"AuthorizedOfficialFirstName": "JENNYBETH",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "909-319-0635",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251G00000X",
"TaxonomyName": "Community Based Hospice Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}