{
"Npi": {
"NPI": "1932583267",
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROACTIVE HEALTHCARE SERVICES, LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5700 KIRKWOOD HWY",
"SecondLineMailingAddress": "SUITE 105 A",
"MailingAddressCityName": "WILMINGTON",
"MailingAddressStateName": "DE",
"MailingAddressPostalCode": "19808-4857",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-451-9944",
"MailingAddressFaxNumber": "484-540-8391",
"FirstLinePracticeLocationAddress": "5700 KIRKWOOD HWY",
"SecondLinePracticeLocationAddress": "SUITE 105A",
"PracticeLocationAddressCityName": "WILMINGTON",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19808-4857",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-452-9944",
"PracticeLocationAddressFaxNumber": "302-370-5002",
"EnumerationDate": "07/16/2015",
"LastUpdateDate": "07/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUNDOR",
"AuthorizedOfficialFirstName": "RACHEAL",
"AuthorizedOfficialMiddleName": "CHRISTIANA",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MISS",
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"AuthorizedOfficialCredential": "LPN",
"AuthorizedOfficialTelephoneNumber": "18774519944",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "HHAS-059",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}