{
"Npi": {
"NPI": "1114962073",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MANOR CARE-WEST DEPTFORD OF PAULSBORO NJ LLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "333 N SUMMIT ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TOLEDO",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43604-2615",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-252-5500",
"MailingAddressFaxNumber": "877-385-9446",
"FirstLinePracticeLocationAddress": "550 JESSUP RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PAULSBORO",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08066-1921",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "856-848-9551",
"PracticeLocationAddressFaxNumber": "856-848-1817",
"EnumerationDate": "06/17/2006",
"LastUpdateDate": "01/17/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLEN",
"AuthorizedOfficialFirstName": "MARTIN",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "DIRECTOR",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "419-252-5743",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "060807",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}