{
"Npi": {
"NPI": "1952807414",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOLDFAST RECOVERY",
"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": "1579 W GURLEY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PRESCOTT",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "86305-2829",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-351-6858",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1579 W GURLEY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PRESCOTT",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "86305-2829",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "928-925-7856",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/03/2018",
"LastUpdateDate": "10/10/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCDONOUGH",
"AuthorizedOfficialFirstName": "BRENDAN",
"AuthorizedOfficialMiddleName": "JAMES",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "928-589-4617",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QR0405X",
"TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "276400000X",
"TaxonomyName": "Substance Use Disorder Rehabilitation Hospital Unit",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}