{
"Npi": {
"NPI": "1386984565",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COUNTRY LIVING MANAGEMENT COMPANY",
"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": "12335 13TH ST NW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPICER",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "56288-9316",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "320-269-9000",
"MailingAddressFaxNumber": "320-269-8008",
"FirstLinePracticeLocationAddress": "4000 COUNTY ROAD 15 SW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MONTEVIDEO",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "56265-4005",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "320-269-9000",
"PracticeLocationAddressFaxNumber": "320-269-8008",
"EnumerationDate": "02/25/2013",
"LastUpdateDate": "02/25/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIBSON",
"AuthorizedOfficialFirstName": "LUANNE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "32026990001",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "360364",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}