{
"Npi": {
"NPI": "1942621768",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ARROWHEAD RANCH INC.",
"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": "12228 104TH ST",
"SecondLineMailingAddress": "P.O. BOX 370",
"MailingAddressCityName": "COAL VALLEY",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61240-9712",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "309-799-7044",
"MailingAddressFaxNumber": "309-799-7090",
"FirstLinePracticeLocationAddress": "12228 104TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COAL VALLEY",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61240-9712",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "309-799-7044",
"PracticeLocationAddressFaxNumber": "309-799-7090",
"EnumerationDate": "12/20/2013",
"LastUpdateDate": "12/20/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOODY",
"AuthorizedOfficialFirstName": "ANGELA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "309-799-7044",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "322D00000X",
"TaxonomyName": "Emotionally Disturbed Childrens' Residential Treatment Facility",
"LicenseNumber": "001583-11",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}