{
"Npi": {
"NPI": "1427758200",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "LIFE FOR SENIORS LLC",
"ParentOrgTIN": null,
"OrgName": "INDEPENDENT LIFESTYLES, LLC",
"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": "806 CHURCH ST",
"SecondLineMailingAddress": "UNIT 1",
"MailingAddressCityName": "ALLENTON",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53002",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-888-2599",
"MailingAddressFaxNumber": "414-892-4970",
"FirstLinePracticeLocationAddress": "4013 S 119TH STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENFIELD",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53228",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-888-2599",
"PracticeLocationAddressFaxNumber": "414-892-4970",
"EnumerationDate": "03/09/2023",
"LastUpdateDate": "03/09/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHNEIDER",
"AuthorizedOfficialFirstName": "RACHEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "636-734-4327",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "311Z00000X",
"TaxonomyName": "Custodial Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}