{
"Npi": {
"NPI": "1255547634",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "TRILOGY INVESTORS, LLC",
"ParentOrgTIN": null,
"OrgName": "TRILOGY HEALTHCARE OF GLEN RIDGE, LLC",
"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": "6415 CALM RIVER WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40299-3250",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "502-297-8590",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6415 CALM RIVER WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOUISVILLE",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40299-3250",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "502-297-8590",
"PracticeLocationAddressFaxNumber": "502-297-8766",
"EnumerationDate": "05/15/2007",
"LastUpdateDate": "09/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PIETROWSKI",
"AuthorizedOfficialFirstName": "CRISTINA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EVP & CLO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "502-213-7572",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "100729",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}