{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15000 SHELL POINT BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT MYERS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33908-1657",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "239-454-2175",
"MailingAddressFaxNumber": "239-454-2221",
"FirstLinePracticeLocationAddress": "3600 KINGS CROWN CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT MYERS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33908-1648",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "239-454-2179",
"PracticeLocationAddressFaxNumber": "239-454-2221",
"EnumerationDate": "11/04/2013",
"LastUpdateDate": "01/28/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SOUTHERN",
"AuthorizedOfficialFirstName": "RITA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "DIRECTOR OF ASSISTED LIVING",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "239-454-2179",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "AL6012",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}