{
"Npi": {
"NPI": "1114974243",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PARK HAVEN INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2125 W PROSPECT RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ASHTABULA",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44004-6439",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "440-992-8387",
"MailingAddressFaxNumber": "440-992-7650",
"FirstLinePracticeLocationAddress": "4533 PARK AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ASHTABULA",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44004-6930",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "440-992-9441",
"PracticeLocationAddressFaxNumber": "440-992-7592",
"EnumerationDate": "05/26/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KNOWLSON",
"AuthorizedOfficialFirstName": "BEATRICE",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN/LNHA",
"AuthorizedOfficialTelephoneNumber": "440-992-8387",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": "6091",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}