{
"Npi": {
"NPI": "1225256696",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WOODSTOCK CHRISTIAN LIFE SERVICES",
"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": "318 CHRISTIAN WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODSTOCK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60098-2912",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-334-6200",
"MailingAddressFaxNumber": "815-206-0472",
"FirstLinePracticeLocationAddress": "920 N SEMINARY AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WOODSTOCK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60098-2996",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-334-6200",
"PracticeLocationAddressFaxNumber": "815-338-8846",
"EnumerationDate": "04/23/2007",
"LastUpdateDate": "07/13/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOSWELL",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VICE PRESIDENT OF FINANCE",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "716-338-9766",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "6009310",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}