{
"Npi": {
"NPI": "1750434098",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROVIDENCE HEALTH SYSTEM OF WASHINGTON",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "914 S SCHEUBER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CENTRALIA",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98531-9027",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "360-330-8815",
"MailingAddressFaxNumber": "360-330-8812",
"FirstLinePracticeLocationAddress": "500 SE WASHINGTON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHEHALIS",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98532-3058",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-740-6542",
"PracticeLocationAddressFaxNumber": "360-740-8367",
"EnumerationDate": "01/19/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOUCHER",
"AuthorizedOfficialFirstName": "KEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ASSISTANT ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "360-330-8541",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}