{
"Npi": {
"NPI": "1144241324",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE OHIO MASONIC HOME",
"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": "PO BOX 120",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45501-0120",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "937-525-3048",
"MailingAddressFaxNumber": "937-525-8302",
"FirstLinePracticeLocationAddress": "4931 NETTLETON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MEDINA",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44256-3232",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-721-3000",
"PracticeLocationAddressFaxNumber": "330-721-3279",
"EnumerationDate": "07/22/2006",
"LastUpdateDate": "02/03/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUCHANAN",
"AuthorizedOfficialFirstName": "SCOTT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "937-525-4975",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "6114",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "6113",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}