{
"Npi": {
"NPI": "1750521027",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DIVINE REVITALIZATION MANAGEMENT INCORPORATED",
"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": "205 DELUCA RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GOLDSBORO",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27534-4417",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-751-1254",
"MailingAddressFaxNumber": "919-751-1254",
"FirstLinePracticeLocationAddress": "102 TRAILWOOD DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DUDLEY",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28333-9466",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-330-4601",
"PracticeLocationAddressFaxNumber": "919-330-4601",
"EnumerationDate": "02/26/2009",
"LastUpdateDate": "02/26/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HERRING",
"AuthorizedOfficialFirstName": "ROCHELLE",
"AuthorizedOfficialMiddleName": "NICOLE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BS",
"AuthorizedOfficialTelephoneNumber": "919-396-2586",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0850X",
"TaxonomyName": "Adult Mental Health Clinic/Center",
"LicenseNumber": "MHL-096-218",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}