{
"Npi": {
"NPI": "1164409801",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GERRY NURSING HOME COMPANY",
"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": "4570 ROUTE 60",
"SecondLineMailingAddress": "PO BOX 351",
"MailingAddressCityName": "GERRY",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14740-9540",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-985-4612",
"MailingAddressFaxNumber": "716-985-4197",
"FirstLinePracticeLocationAddress": "4570 ROUTE 60",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GERRY",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14740-9540",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-985-4612",
"PracticeLocationAddressFaxNumber": "716-985-4197",
"EnumerationDate": "12/23/2005",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LYNCH",
"AuthorizedOfficialFirstName": "KATHLEEN",
"AuthorizedOfficialMiddleName": "A.",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "716-985-4612",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "0662300N",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}