{
"Npi": {
"NPI": "1821124769",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AMIGO HEALTHCARE, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1908",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAREDO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78044-1908",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "956-795-8705",
"MailingAddressFaxNumber": "956-791-2554",
"FirstLinePracticeLocationAddress": "1812 COMMERCE DR",
"SecondLinePracticeLocationAddress": "SUITE 3B",
"PracticeLocationAddressCityName": "LAREDO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78041-2843",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "956-795-8705",
"PracticeLocationAddressFaxNumber": "956-791-2554",
"EnumerationDate": "02/26/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARZA",
"AuthorizedOfficialFirstName": "CARLOS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "956-795-8705",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "011000",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}