{
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"FirstLineMailingAddress": "18504 61ST PL NE",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "18504 61ST PL NE",
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"PracticeLocationAddressCityName": "KENMORE",
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"EnumerationDate": "03/14/2025",
"LastUpdateDate": "03/17/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GHEBREYOUHANNS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "374U00000X",
"TaxonomyName": "Home Health Aide",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}