{
"Npi": {
"NPI": "1326433681",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PORTLAND HEALTHCARE INC",
"ParentOrgTIN": null,
"OrgName": "PORTLAND ASSISTED LIVING FACILITY",
"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": "8758 COBBLESTONE POINT CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOYNTON BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33472-4458",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-870-8546",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4664 NW 58TH TER",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORAL SPRINGS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33067-2115",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-603-6954",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/03/2015",
"LastUpdateDate": "04/03/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOODIE",
"AuthorizedOfficialFirstName": "RANDY",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D",
"AuthorizedOfficialTelephoneNumber": "561-870-8546",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "AL12536",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}