{
"Npi": {
"NPI": "1962658500",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SYRINGA FAMILY PARTNERSHIP, 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": "PO BOX 844",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAYDEN",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83835-0844",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-771-1551",
"MailingAddressFaxNumber": "208-676-1030",
"FirstLinePracticeLocationAddress": "3650 N GOVERNMENT WAY",
"SecondLinePracticeLocationAddress": "SUITE L",
"PracticeLocationAddressCityName": "COEUR D ALENE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83815-8331",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-676-1693",
"PracticeLocationAddressFaxNumber": "208-676-1030",
"EnumerationDate": "08/14/2008",
"LastUpdateDate": "08/14/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SISK",
"AuthorizedOfficialFirstName": "COLLEEN",
"AuthorizedOfficialMiddleName": "IRENE",
"AuthorizedOfficialTitle": "OWNER / DIRECTOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BSW",
"AuthorizedOfficialTelephoneNumber": "208-771-1551",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}