{
"Npi": {
"NPI": "1902080146",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROYALTY PERSONAL 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": "1532 SOUTH BURNSIDE AVE.SUITE 10 A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GONZALES",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70707",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "225-677-9769",
"MailingAddressFaxNumber": "225-313-3488",
"FirstLinePracticeLocationAddress": "1532 S BURNSIDE AVE BLDG 10A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GONZALES",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70737-4444",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "225-677-9769",
"PracticeLocationAddressFaxNumber": "225-313-3488",
"EnumerationDate": "12/24/2007",
"LastUpdateDate": "12/24/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIMMONS",
"AuthorizedOfficialFirstName": "SHANNON",
"AuthorizedOfficialMiddleName": "WILLIAMS",
"AuthorizedOfficialTitle": "PROGRAM ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "225-803-8217",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "PCA 14063",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}