{
"Npi": {
"NPI": "1942792312",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COUNTRY COTTAGE ON MAIN STREET ADULT DAY CARE CENTER, LLC",
"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": "201 S MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKSVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34601-3337",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-433-8100",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "201 S MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BROOKSVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34601-3337",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-433-8100",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/01/2018",
"LastUpdateDate": "06/01/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TRENTINO",
"AuthorizedOfficialFirstName": "TERESA",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "727-459-1189",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}