{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "1240 N VAN BUREN ST STE 202",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANAHEIM",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92807-1602",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-576-7210",
"MailingAddressFaxNumber": "714-333-4307",
"FirstLinePracticeLocationAddress": "1240 N VAN BUREN ST STE 202",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANAHEIM",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-576-7210",
"PracticeLocationAddressFaxNumber": "714-333-4307",
"EnumerationDate": "05/13/2020",
"LastUpdateDate": "11/09/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHOUDHARY",
"AuthorizedOfficialFirstName": "SIAMA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "714-232-9337",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community Based Hospice Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}