{
"Npi": {
"NPI": "1275572646",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE WATERS OF YORKTOWN, LLC",
"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": "240 FENCL LANE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HILLSIDE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60162-2067",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-449-1900",
"MailingAddressFaxNumber": "708-449-1500",
"FirstLinePracticeLocationAddress": "2000 S. ANDREWS ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YORKTOWN",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "47396-6812",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "765-759-7740",
"PracticeLocationAddressFaxNumber": "765-759-7131",
"EnumerationDate": "06/04/2006",
"LastUpdateDate": "09/20/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SORSCHER",
"AuthorizedOfficialFirstName": "ALAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "708-449-1900",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "05-000143-1",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}