{
"Npi": {
"NPI": "1326093261",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EAST LAKE CARE CENTER, 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": "PO BOX 57850",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MURRAY",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84157-0850",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-268-1122",
"MailingAddressFaxNumber": "801-268-1150",
"FirstLinePracticeLocationAddress": "101 N 500 W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PROVO",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84601-2646",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-377-9661",
"PracticeLocationAddressFaxNumber": "801-377-9747",
"EnumerationDate": "05/22/2006",
"LastUpdateDate": "01/03/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "CRAIG",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "801-268-1122",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332BN1400X",
"TaxonomyName": "Nursing Facility Supplies (DME)",
"LicenseNumber": "2007-NCF-292",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332BP3500X",
"TaxonomyName": "Parenteral & Enteral Nutrition Supplies (DME)",
"LicenseNumber": "2007-NCF-292",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "2004-NCF-292",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}