{
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"ParentOrgLBN": null,
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"LastName": null,
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"FirstLineMailingAddress": "1601 68TH LN N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKLYN CENTER",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55430-5800",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-290-7144",
"MailingAddressFaxNumber": "612-662-6817",
"FirstLinePracticeLocationAddress": "1601 68TH LN N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BROOKLYN CENTER",
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"PracticeLocationAddressTelephoneNumber": "612-290-7144",
"PracticeLocationAddressFaxNumber": "612-662-6817",
"EnumerationDate": "04/16/2026",
"LastUpdateDate": "04/16/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NJI",
"AuthorizedOfficialFirstName": "VALENTINE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "612-290-7144",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}