{
"Npi": {
"NPI": "1053539700",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SURPRISE RESIDENTIAL ASSISTED LIVING",
"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": "17633 N 14TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHOENIX",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85022-2001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "602-404-8196",
"MailingAddressFaxNumber": "602-595-1659",
"FirstLinePracticeLocationAddress": "17218 W STATLER ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SURPRISE",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85388-1265",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "602-369-1254",
"PracticeLocationAddressFaxNumber": "602-595-1659",
"EnumerationDate": "04/20/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARRY",
"AuthorizedOfficialFirstName": "SHAIBA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "REGISTERED NURSE",
"AuthorizedOfficialTelephoneNumber": "602-404-8196",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}