{
"Npi": {
"NPI": "1932138823",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WILLOUGH HEALTHCARE, 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": "7074 GROVE RD # 129",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKSVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34609-8658",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-978-1933",
"MailingAddressFaxNumber": "352-610-9996",
"FirstLinePracticeLocationAddress": "9001 TAMIAMI TRL E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NAPLES",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34113-3304",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "239-775-4500",
"PracticeLocationAddressFaxNumber": "239-755-2990",
"EnumerationDate": "07/02/2006",
"LastUpdateDate": "11/06/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROBERTS",
"AuthorizedOfficialFirstName": "TRACY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR REVENUE CYCLE MANAGEMENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "423-895-0084",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "283Q00000X",
"TaxonomyName": "Psychiatric Hospital",
"LicenseNumber": "4212",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}