{
"Npi": {
"NPI": "1760993554",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TRIWELLNESS HOLISTIC CENTER LLC",
"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": "14 DORCHESTER ST STE 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTH BOSTON",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02127-1306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "508-617-0070",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "14 DORCHESTER ST STE 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTH BOSTON",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02127-1306",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "508-617-0070",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/19/2017",
"LastUpdateDate": "10/19/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SOLDEVILLA",
"AuthorizedOfficialFirstName": "CAROL",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PARTNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LICSW",
"AuthorizedOfficialTelephoneNumber": "508-610-0070",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": "115897",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}