{
"Npi": {
"NPI": "1790842987",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VNA OF GREATER BAMBERG, INC.",
"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": "923 MIDWAY ST",
"SecondLineMailingAddress": "PO BOX 1048",
"MailingAddressCityName": "BAMBERG",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29003-1957",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "803-245-5611",
"MailingAddressFaxNumber": "803-245-3259",
"FirstLinePracticeLocationAddress": "923 MIDWAY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BAMBERG",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29003-1957",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "803-245-5611",
"PracticeLocationAddressFaxNumber": "803-245-3259",
"EnumerationDate": "01/03/2007",
"LastUpdateDate": "02/04/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GWALTNEY",
"AuthorizedOfficialFirstName": "JAVY",
"AuthorizedOfficialMiddleName": "RUDOLPH",
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "803-245-5611",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "HHA-045",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}