{
"Npi": {
"NPI": "1912195975",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HARTSELLS TEEN FOCUS,INC",
"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": "5952 GILBERT DAVIS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RANDLEMAN",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27317-7177",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-442-1805",
"MailingAddressFaxNumber": "336-434-0175",
"FirstLinePracticeLocationAddress": "323 NC HWY 62 EAST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENSBORO",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27406",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-442-1805",
"PracticeLocationAddressFaxNumber": "336-434-0175",
"EnumerationDate": "10/04/2007",
"LastUpdateDate": "10/04/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARTSELL",
"AuthorizedOfficialFirstName": "TERESA",
"AuthorizedOfficialMiddleName": "FAGAN",
"AuthorizedOfficialTitle": "EXCUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "336-442-1805",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "322D00000X",
"TaxonomyName": "Emotionally Disturbed Childrens' Residential Treatment Facility",
"LicenseNumber": "MHL-041-836",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}