{
"Npi": {
"NPI": "1750412672",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROFFITT'S RESIDENTIAL",
"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": "615 W WASHINGTON ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CENTERVILLE",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "52544-1623",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "641-856-8344",
"MailingAddressFaxNumber": "641-437-4161",
"FirstLinePracticeLocationAddress": "615 WEST WASHINGTON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CENTERVILLE",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "52544-1623",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "641-856-8344",
"PracticeLocationAddressFaxNumber": "641-437-4161",
"EnumerationDate": "03/09/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PROFFITT",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": "CATHERINE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "641-856-8344",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": "R542",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}