{
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 468",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HARRISBURG",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62946-0468",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-252-7405",
"MailingAddressFaxNumber": "618-253-3418",
"FirstLinePracticeLocationAddress": "120 S LAND ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HARRISBURG",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "618-252-7405",
"PracticeLocationAddressFaxNumber": "618-253-3418",
"EnumerationDate": "02/14/2017",
"LastUpdateDate": "02/14/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STOUT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "618-713-5284",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}