{
"Npi": {
"NPI": "1821126707",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STATE OF TEXAS, DEPT. OF AGING & DISABILITY, HCSSA",
"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": "2900 W ANDERSON LN",
"SecondLineMailingAddress": "C200-126",
"MailingAddressCityName": "AUSTIN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78757-1102",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-484-4907",
"MailingAddressFaxNumber": "512-908-3212",
"FirstLinePracticeLocationAddress": "10205 N LAMAR",
"SecondLinePracticeLocationAddress": "FIRST FLOOR",
"PracticeLocationAddressCityName": "AUSTIN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78753",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "512-908-3204",
"PracticeLocationAddressFaxNumber": "512-908-3212",
"EnumerationDate": "03/01/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JACKSON",
"AuthorizedOfficialFirstName": "BILL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MSW",
"AuthorizedOfficialTelephoneNumber": "512-908-3203",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": "236258",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}