{
"Npi": {
"NPI": "1780921148",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CEICARE THERAPEUTIC DEVELOPMENT & HEALTH RESOURCE MANAGEMENT",
"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": "3020 PROSPERITY CHURCH RD",
"SecondLineMailingAddress": "UNIT 178",
"MailingAddressCityName": "CHARLOTTE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28269-7197",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-605-5989",
"MailingAddressFaxNumber": "980-335-0434",
"FirstLinePracticeLocationAddress": "3020 PROSPERITY CHURCH RD",
"SecondLinePracticeLocationAddress": "UNIT 178",
"PracticeLocationAddressCityName": "CHARLOTTE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28269-7197",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-605-5989",
"PracticeLocationAddressFaxNumber": "980-335-0434",
"EnumerationDate": "01/04/2013",
"LastUpdateDate": "01/04/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FERNANDO",
"AuthorizedOfficialFirstName": "JAY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "980-230-6654",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}