{
"Npi": {
"NPI": "1437247129",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GRACE STREET ASSOCIATES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1503 GRACE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LYNCHBURG",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24504-3211",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "434-528-0969",
"MailingAddressFaxNumber": "434-846-3549",
"FirstLinePracticeLocationAddress": "1503 GRACE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LYNCHBURG",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24504-3211",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-528-0969",
"PracticeLocationAddressFaxNumber": "434-846-3549",
"EnumerationDate": "10/10/2006",
"LastUpdateDate": "09/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOOTEN",
"AuthorizedOfficialFirstName": "CAROLYN",
"AuthorizedOfficialMiddleName": "E.",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LNHA",
"AuthorizedOfficialTelephoneNumber": "434-528-0969",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": "NH2561",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "RO06002",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}