{
"Npi": {
"NPI": "1083957039",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRIDGEPORT SENIOR LIVING LLC",
"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": "13546 DARCHANCE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINDERMERE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34786-6305",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-760-3648",
"MailingAddressFaxNumber": "877-784-0844",
"FirstLinePracticeLocationAddress": "8341 LAKE CROWELL CIR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ORLANDO",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32836-5931",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-730-2582",
"PracticeLocationAddressFaxNumber": "407-730-2642",
"EnumerationDate": "03/28/2013",
"LastUpdateDate": "03/28/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GALBASINI",
"AuthorizedOfficialFirstName": "KEVIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "407-760-3649",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "AL2280",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}