{
"Npi": {
"NPI": "1972733053",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "REACHING OUT MINISTRIES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "226 CHALAN SAN ANTONIO STE C",
"SecondLineMailingAddress": "AMPARO'S BUSINESS CENTER",
"MailingAddressCityName": "TAMUNING",
"MailingAddressStateName": "GU",
"MailingAddressPostalCode": "96913-3525",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "671-646-2010",
"MailingAddressFaxNumber": "671-646-2070",
"FirstLinePracticeLocationAddress": "226 CHALAN SAN ANTONIO STE C",
"SecondLinePracticeLocationAddress": "AMPARO'S BUSINESS CENTER",
"PracticeLocationAddressCityName": "TAMUNING",
"PracticeLocationAddressStateName": "GU",
"PracticeLocationAddressPostalCode": "96913-3525",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "671-646-2010",
"PracticeLocationAddressFaxNumber": "671-646-2070",
"EnumerationDate": "07/22/2009",
"LastUpdateDate": "07/22/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOURGEOIS",
"AuthorizedOfficialFirstName": "KENNY",
"AuthorizedOfficialMiddleName": "WAYNE",
"AuthorizedOfficialTitle": "PRESIDENT/PRIMARY DENTAL PROVIDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "671-646-2010",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "14605",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "D927",
"LicenseNumberStateCode": "GU",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}