{
"Npi": {
"NPI": "1194920488",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LAKEWOOD ADULT FAMILY HOME INC",
"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": "POB 1543",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CASTLETON",
"MailingAddressStateName": "VT",
"MailingAddressPostalCode": "05735-1543",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "802-468-3010",
"MailingAddressFaxNumber": "802-468-5374",
"FirstLinePracticeLocationAddress": "69 RAINBOWS END",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOMOSEEN",
"PracticeLocationAddressStateName": "VT",
"PracticeLocationAddressPostalCode": "05732-4417",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "802-468-3010",
"PracticeLocationAddressFaxNumber": "802-468-5374",
"EnumerationDate": "06/18/2007",
"LastUpdateDate": "06/24/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHURCH",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "JAMES",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "802-468-3010",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": "544",
"LicenseNumberStateCode": "VT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}