{
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"EIN": null,
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"IsOrgSubpart": "Y",
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"NamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "195 EXECUTIVE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARION",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43302-6343",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "740-387-9545",
"MailingAddressFaxNumber": "740-382-3810",
"FirstLinePracticeLocationAddress": "195 EXECUTIVE DR",
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"PracticeLocationAddressCityName": "MARION",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "740-387-9545",
"PracticeLocationAddressFaxNumber": "740-382-3810",
"EnumerationDate": "10/05/2005",
"LastUpdateDate": "07/12/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROOT",
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"AuthorizedOfficialTitle": "ADMINISTRATOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "740-387-9545",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "1473",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}