{
"Npi": {
"NPI": "1952313819",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CQ HOME HEALTH ACQUISITION HOLDINGS LP",
"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": "PO BOX 1387",
"SecondLineMailingAddress": "412 HWY 37 SOUTH",
"MailingAddressCityName": "MOUNT VERNON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75457-1387",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-537-8629",
"MailingAddressFaxNumber": "903-537-8440",
"FirstLinePracticeLocationAddress": "1101 BROOK AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WICHITA FALLS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76301-5008",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "940-761-6191",
"PracticeLocationAddressFaxNumber": "940-761-6194",
"EnumerationDate": "08/12/2006",
"LastUpdateDate": "05/24/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HERRERA",
"AuthorizedOfficialFirstName": "CARLA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BILLING MANAGER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "903-537-8629",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "009382",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}