{
"Npi": {
"NPI": "1861683724",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RIVERSIDE RECOVERY",
"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": "1720 18TH AVE",
"SecondLineMailingAddress": "PO BOX 2287",
"MailingAddressCityName": "LEWISTON",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83501-4047",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-746-4097",
"MailingAddressFaxNumber": "208-746-2294",
"FirstLinePracticeLocationAddress": "155 MAIN STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OROFINO",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83544-2287",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-476-9393",
"PracticeLocationAddressFaxNumber": "208-476-7932",
"EnumerationDate": "08/06/2007",
"LastUpdateDate": "08/06/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOYD",
"AuthorizedOfficialFirstName": "DANA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BUSINESS OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "208-746-4097",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "101YA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
"LicenseNumber": "138",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}