{
"Npi": {
"NPI": "1255460259",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANNIE L LONG",
"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": "PO BOX 1112",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YANCEYVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27379-1112",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-694-9505",
"MailingAddressFaxNumber": "336-694-1107",
"FirstLinePracticeLocationAddress": "591 MARSHALL GRAVES RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YANCEYVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27379-8600",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-694-9505",
"PracticeLocationAddressFaxNumber": "336-694-1107",
"EnumerationDate": "03/05/2007",
"LastUpdateDate": "08/16/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LONG",
"AuthorizedOfficialFirstName": "ANNIE",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "336-694-9505",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": "FCL017011",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}