{
"Npi": {
"NPI": "1194140509",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SENIOR LIFE LLC",
"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": "PO BOX 48857",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TAMPA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33646-0124",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-319-0961",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "619 ORANGE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DAYTONA BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32114-4786",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "813-319-0961",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/20/2014",
"LastUpdateDate": "02/20/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHERRY",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "SENIOR ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "II",
"AuthorizedOfficialCredential": "J.D., M.B.A.",
"AuthorizedOfficialTelephoneNumber": "813-267-7342",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}