{
"Npi": {
"NPI": "1023002318",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRESENCE SENIOR SERVICES CHICAGOLAND",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "480 N WOLF RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTHLAKE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60164-1650",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-562-0040",
"MailingAddressFaxNumber": "708-562-6623",
"FirstLinePracticeLocationAddress": "480 N WOLF RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH LAKE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60164",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-562-0040",
"PracticeLocationAddressFaxNumber": "708-562-5180",
"EnumerationDate": "09/01/2005",
"LastUpdateDate": "07/22/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRONEFELD",
"AuthorizedOfficialFirstName": "KELLIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "314-729-3500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "0044792",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}