{
"Npi": {
"NPI": "1821255258",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STAR ICF/DD-N WAKEFIELD HOME",
"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": "14621 WAKEFIELD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTMINSTER",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92683-5718",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-400-1503",
"MailingAddressFaxNumber": "174-183-9863",
"FirstLinePracticeLocationAddress": "14621 WAKEFIELD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTMINSTER",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92683-5718",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-400-1503",
"PracticeLocationAddressFaxNumber": "174-183-9863",
"EnumerationDate": "05/22/2008",
"LastUpdateDate": "05/22/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DE LOS ANGELES",
"AuthorizedOfficialFirstName": "LIZA",
"AuthorizedOfficialMiddleName": "DARADAR",
"AuthorizedOfficialTitle": "OWNER/ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "562-400-1503",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": "550000699",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}