{
"Npi": {
"NPI": "1366430399",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HIGHLANDS LAKE CENTER, 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": "4240 LAKELAND HIGHLANDS RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKELAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33813-3113",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-646-8699",
"MailingAddressFaxNumber": "863-644-3475",
"FirstLinePracticeLocationAddress": "4240 LAKELAND HIGHLANDS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKELAND",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33813-3113",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-646-8699",
"PracticeLocationAddressFaxNumber": "863-644-3475",
"EnumerationDate": "10/13/2005",
"LastUpdateDate": "06/12/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ZIOLKOWSKI",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "ALISE",
"AuthorizedOfficialTitle": "VP FINANCE",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MBA",
"AuthorizedOfficialTelephoneNumber": "813-558-6629",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "SNF1345096",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}