{
"Npi": {
"NPI": "1891813028",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANGELS FAMILY CARE HOME #4",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "210 UNION AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BURLINGTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27217-2442",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-570-5770",
"MailingAddressFaxNumber": "336-228-9376",
"FirstLinePracticeLocationAddress": "210 UNION AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BURLINGTON",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27217-2442",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-570-5770",
"PracticeLocationAddressFaxNumber": "336-228-9376",
"EnumerationDate": "03/26/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRAVES",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "336-222-9297",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311Z00000X",
"TaxonomyName": "Custodial Care Facility",
"LicenseNumber": "MHL-001-113",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}