{
"Npi": {
"NPI": "1942343041",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MEDSOURCE COMMUNITY SERVICES INC. DBA SENIOR HOME CARE OF FREDERICK",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1315 ORCHARD WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREDERICK",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21703-6002",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-846-0160",
"MailingAddressFaxNumber": "301-846-0267",
"FirstLinePracticeLocationAddress": "6910 BOWERS RD STE C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FREDERICK",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21702-3614",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-473-5633",
"PracticeLocationAddressFaxNumber": "301-473-8585",
"EnumerationDate": "02/15/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLAXTON",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "301-991-6963",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": "R2122",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}