{
"Npi": {
"NPI": "1104420785",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "COMMUNITY COMPASSION CENTERS OF ARKANSAS",
"ParentOrgTIN": null,
"OrgName": "COMMUNITY COMPASSION GLENWOOD",
"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": "5921 H ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LITTLE ROCK",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72205-3239",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "615 MOUNTAIN VIEW RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLENWOOD",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "71943-9061",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "870-356-3953",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/24/2020",
"LastUpdateDate": "11/24/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TEETER",
"AuthorizedOfficialFirstName": "JENNY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ATTORNEY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "501-376-3800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}