{
"Npi": {
"NPI": "1841544343",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AREVV INC",
"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": "740 WATERS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VIRGINIA BEACH",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23462-4882",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "757-717-8880",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "328 N GREAT NECK RD",
"SecondLinePracticeLocationAddress": "SUITE 103",
"PracticeLocationAddressCityName": "VIRGINIA BEACH",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23454-4060",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-965-6823",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/05/2012",
"LastUpdateDate": "11/05/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANTACK",
"AuthorizedOfficialFirstName": "VERA",
"AuthorizedOfficialMiddleName": "LOUISE",
"AuthorizedOfficialTitle": "PRESIDENT AND OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "COSMETOLOGIST",
"AuthorizedOfficialTelephoneNumber": "757-717-8880",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": "1201103891",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}