{
"Npi": {
"NPI": "1992767800",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WEST VALLEY LIFELINE SERVICES",
"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": "1717 ARLINGTON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CALDWELL",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83605-4802",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-455-3754",
"MailingAddressFaxNumber": "208-455-3955",
"FirstLinePracticeLocationAddress": "1717 ARLINGTON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CALDWELL",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83605-4802",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-455-3754",
"PracticeLocationAddressFaxNumber": "208-455-3955",
"EnumerationDate": "04/05/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MYRICK",
"AuthorizedOfficialFirstName": "WAYNE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PROGRAM MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "208-455-3754",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": "332B00000X",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}