{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "DESTINY YOUTH EMPOWERMENT PROGRAM",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "623 MERCURY AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DUNCANVILLE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75137-2235",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "832-881-2800",
"MailingAddressFaxNumber": "972-283-6661",
"FirstLinePracticeLocationAddress": "623 MERCURY AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DUNCANVILLE",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "832-881-2800",
"PracticeLocationAddressFaxNumber": "972-283-6661",
"EnumerationDate": "04/21/2017",
"LastUpdateDate": "04/21/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANOZIE",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": "O",
"AuthorizedOfficialTitle": "PROGRAM ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "832-881-2800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}