{
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "1800 N WABASH RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARION",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46952-1300",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "765-664-5400",
"MailingAddressFaxNumber": "765-664-5403",
"FirstLinePracticeLocationAddress": "701 OVERLOOK DR",
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"PracticeLocationAddressCityName": "WINTER HAVEN",
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"PracticeLocationAddressTelephoneNumber": "863-318-5000",
"PracticeLocationAddressFaxNumber": "863-324-7251",
"EnumerationDate": "12/16/2013",
"LastUpdateDate": "12/16/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIBSON",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Assisted Living Facility",
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"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}