{
"Npi": {
"NPI": "1871225102",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "NEXUS HEALTH SYSTEM",
"ParentOrgTIN": null,
"OrgName": "NEXUS NEURORECOVERY CENTER- SAN ANTONIO",
"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": "1 RIVERWAY STE 700",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOUSTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77056-1988",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "713-589-4136",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "227 LEWIS ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN ANTONIO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78212-5515",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "713-355-6111",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/27/2022",
"LastUpdateDate": "10/11/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CASSIDY",
"AuthorizedOfficialFirstName": "ERIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "713-589-4136",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "323P00000X",
"TaxonomyName": "Psychiatric Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3245S0500X",
"TaxonomyName": "Children's Substance Abuse Rehabilitation Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "320600000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "320700000X",
"TaxonomyName": "Physical Disabilities Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}