{
"Npi": {
"NPI": "1841441037",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "R&M WELTY 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": "6324 RIVERDALE DR NW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RAMSEY",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55303-4800",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "763-753-9884",
"MailingAddressFaxNumber": "763-208-1665",
"FirstLinePracticeLocationAddress": "6324 RIVERDALE DR NW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RAMSEY",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55303-4800",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "763-355-9190",
"PracticeLocationAddressFaxNumber": "763-208-1665",
"EnumerationDate": "10/06/2008",
"LastUpdateDate": "08/03/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WELTY",
"AuthorizedOfficialFirstName": "MYRON",
"AuthorizedOfficialMiddleName": "IMRI",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "I",
"AuthorizedOfficialCredential": "REGISTERED NURSE",
"AuthorizedOfficialTelephoneNumber": "763-753-9884",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "320800000X",
"TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
"LicenseNumber": "1080415-1-HCBS",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}