{
"Npi": {
"NPI": "1972696144",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DIVINE COVENANT HEALTHCARE INC.",
"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": "12660 STAFFORD RD",
"SecondLineMailingAddress": "STE 1138",
"MailingAddressCityName": "STAFFORD",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77477-3522",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "713-240-1902",
"MailingAddressFaxNumber": "713-257-6631",
"FirstLinePracticeLocationAddress": "12660 STAFFORD RD",
"SecondLinePracticeLocationAddress": "STE 1138",
"PracticeLocationAddressCityName": "STAFFORD",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77477-3522",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "713-240-1902",
"PracticeLocationAddressFaxNumber": "713-257-6631",
"EnumerationDate": "10/02/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WINFUL",
"AuthorizedOfficialFirstName": "OLUBANJI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "713-240-1902",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "010759",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}