{
"Npi": {
"NPI": "1770899890",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ICOCO ENTERPRISES LIMITED",
"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": "1107 S MANNHEIM RD",
"SecondLineMailingAddress": "SUITE 212",
"MailingAddressCityName": "WESTCHESTER",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60154-2561",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-343-4704",
"MailingAddressFaxNumber": "708-343-4941",
"FirstLinePracticeLocationAddress": "1107 S MANNHEIM RD",
"SecondLinePracticeLocationAddress": "SUITE 212",
"PracticeLocationAddressCityName": "WESTCHESTER",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60154-2561",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-343-4704",
"PracticeLocationAddressFaxNumber": "708-343-4941",
"EnumerationDate": "08/26/2010",
"LastUpdateDate": "08/26/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NWANKPA",
"AuthorizedOfficialFirstName": "SUNDAY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "708-343-4704",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "203.000988",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}