{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "PREMIER PSYCHIATRIC SERVICES, INC",
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"FirstLineMailingAddress": "833 ROYAL TROON PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EL DORADO HILLS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95762-7689",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-294-7062",
"MailingAddressFaxNumber": "916-774-6754",
"FirstLinePracticeLocationAddress": "8775 SIERRA COLLEGE BLVD",
"SecondLinePracticeLocationAddress": "SUITE #200",
"PracticeLocationAddressCityName": "ROSEVILLE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95661-5923",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-294-7062",
"PracticeLocationAddressFaxNumber": "916-490-3697",
"EnumerationDate": "05/18/2016",
"LastUpdateDate": "02/16/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GALERKIN",
"AuthorizedOfficialFirstName": "MITCHELL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "916-294-7062",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "G66328",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}