{
"Npi": {
"NPI": "1982418802",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE 402- OMAHA'S FINEST",
"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": "5348 N 64TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OMAHA",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68104-1534",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-517-6841",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5348 N 64TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OMAHA",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68104-1534",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-517-6841",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/03/2025",
"LastUpdateDate": "02/03/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROADWAY",
"AuthorizedOfficialFirstName": "LATEYA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR OF OPERATIONS",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "402-517-6841",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QA0600X",
"TaxonomyName": "Adult Day Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QC1500X",
"TaxonomyName": "Community Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "385H00000X",
"TaxonomyName": "Respite Care",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}