{
"Npi": {
"NPI": "1952784183",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRIMA VISTA RECOVERY AND WELLNESS 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": "7664 S US HIGHWAY 1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORT SAINT LUCIE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34952-2315",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "772-461-8833",
"MailingAddressFaxNumber": "772-461-8872",
"FirstLinePracticeLocationAddress": "7664 S US HIGHWAY 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORT SAINT LUCIE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34952-2315",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "772-461-8833",
"PracticeLocationAddressFaxNumber": "772-461-8872",
"EnumerationDate": "07/07/2015",
"LastUpdateDate": "07/07/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIBARTOLOMEO",
"AuthorizedOfficialFirstName": "GERALD",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "CPA",
"AuthorizedOfficialTelephoneNumber": "772-461-8833",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0405X",
"TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}