{
"Npi": {
"NPI": "1942377353",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STATSTAFF NURSES, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "100 W ROOSEVELT RD",
"SecondLineMailingAddress": "BUILDING B-5, SUITE 205",
"MailingAddressCityName": "WHEATON",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60187-5260",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-682-0118",
"MailingAddressFaxNumber": "630-682-0137",
"FirstLinePracticeLocationAddress": "100 W ROOSEVELT RD",
"SecondLinePracticeLocationAddress": "BUILDING B-5, SUITE 205",
"PracticeLocationAddressCityName": "WHEATON",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60187-5260",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-682-0118",
"PracticeLocationAddressFaxNumber": "630-682-0137",
"EnumerationDate": "11/29/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILSON",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "EUGENE",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "PRESIDENT",
"AuthorizedOfficialTelephoneNumber": "630-682-0118",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "IL1010609",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}