{
"Npi": {
"NPI": "1851446470",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COOP MANAGED HEALTH CARE LLC",
"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": "5028 ASHLEY LAKE DR",
"SecondLineMailingAddress": "UNIT 331",
"MailingAddressCityName": "BOYNTON BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33437-3176",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-719-0161",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5028 ASHLEY LAKE DRIVE",
"SecondLinePracticeLocationAddress": "UNIT 331",
"PracticeLocationAddressCityName": "BOYNTON BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33437",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-719-0161",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/24/2007",
"LastUpdateDate": "08/08/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FULLER",
"AuthorizedOfficialFirstName": "LINDA",
"AuthorizedOfficialMiddleName": "KAY",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MISS",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "704-719-0161",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "RN 9245770",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}