{
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"OrgName": "MARCIES MANOR III ICF",
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"FirstLineMailingAddress": "5450 SAINT ANDREWS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STOCKTON",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95219-1918",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "209-478-3391",
"MailingAddressFaxNumber": "209-478-3391",
"FirstLinePracticeLocationAddress": "1528 VENETIAN DR",
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"PracticeLocationAddressCityName": "STOCKTON",
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"PracticeLocationAddressTelephoneNumber": "209-952-6122",
"PracticeLocationAddressFaxNumber": "209-478-3391",
"EnumerationDate": "02/03/2007",
"LastUpdateDate": "04/30/2008",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATUBO",
"AuthorizedOfficialFirstName": "MARCIE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "209-478-3391",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "320600000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
"LicenseNumber": "100000773",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}