{
"Npi": {
"NPI": "1043207152",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EVANGELICAL MANOR",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "928 JAYMOR RD",
"SecondLineMailingAddress": "SUITE B-150",
"MailingAddressCityName": "SOUTHAMPTON",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "18966-3826",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-354-9586",
"MailingAddressFaxNumber": "215-354-1435",
"FirstLinePracticeLocationAddress": "8401 ROOSEVELT BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHILADELPHIA",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19152-2034",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-624-5800",
"PracticeLocationAddressFaxNumber": "215-335-1477",
"EnumerationDate": "10/04/2005",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LACHMAN",
"AuthorizedOfficialFirstName": "SUZANNE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NHA",
"AuthorizedOfficialTelephoneNumber": "215-624-5800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "311202",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}