{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "SERENITY DEN",
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"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"Credential": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "33045 PARKHILL ST APT 202",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAYNE",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48184-1339",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-897-6431",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "24567 NORTHWESTERN HWY STE 302A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTHFIELD",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48075-2412",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-897-6431",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/12/2021",
"LastUpdateDate": "03/12/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ADESINA",
"AuthorizedOfficialFirstName": "KHIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MASSAGE THERAPIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMT",
"AuthorizedOfficialTelephoneNumber": "248-897-6431",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}