{
"Npi": {
"NPI": "1912382177",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "VOLUNTEERS OF AMERICA SOUTHEAST LOUISIANA, INC.",
"ParentOrgTIN": null,
"OrgName": "VOLUNTEERS OF AMERICA SOUTHEAST LOUISIANA, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4152 CANAL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW ORLEANS",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70119-5941",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "504-482-2130",
"MailingAddressFaxNumber": "504-482-1922",
"FirstLinePracticeLocationAddress": "1990 SURGI DR STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MANDEVILLE",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70448-2234",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "985-612-1067",
"PracticeLocationAddressFaxNumber": "985-626-5158",
"EnumerationDate": "07/29/2015",
"LastUpdateDate": "09/23/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BURT",
"AuthorizedOfficialFirstName": "JASON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EVP OF ENTERPRISE & ADMINISTRATION",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "504-486-8674",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171WH0202X",
"TaxonomyName": "Home Modifications Contractor",
"LicenseNumber": "556224",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}