{
"Npi": {
"NPI": "1952551756",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RUSH NEUROBEHAVIORAL CENTER",
"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": "4711 GOLF RD",
"SecondLineMailingAddress": "SUITE 1100",
"MailingAddressCityName": "SKOKIE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60076-1224",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-933-9339",
"MailingAddressFaxNumber": "847-933-0874",
"FirstLinePracticeLocationAddress": "4711 GOLF RD",
"SecondLinePracticeLocationAddress": "SUITE 1100",
"PracticeLocationAddressCityName": "SKOKIE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60076-1224",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "847-933-9339",
"PracticeLocationAddressFaxNumber": "847-933-0874",
"EnumerationDate": "09/29/2008",
"LastUpdateDate": "09/29/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIPTON",
"AuthorizedOfficialFirstName": "MERYL",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "PEDIATRIC NEUROLOGIST / EXECUTIVE D",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D., PH.D.",
"AuthorizedOfficialTelephoneNumber": "847-933-9339",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0855X",
"TaxonomyName": "Adolescent and Children Mental Health Clinic/Center",
"LicenseNumber": "036079515",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}