{
"Npi": {
"NPI": "1467096446",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE HERITAGE AT SAGEWOOD OPERATING , 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": "16934 FRANCES ST STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OMAHA",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68130-2397",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-933-2561",
"MailingAddressFaxNumber": "402-933-2673",
"FirstLinePracticeLocationAddress": "1920 SAGEWOOD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND ISLAND",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68803-1585",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "308-398-8005",
"PracticeLocationAddressFaxNumber": "308-675-3325",
"EnumerationDate": "11/01/2019",
"LastUpdateDate": "11/01/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORNWELL",
"AuthorizedOfficialFirstName": "BRANDI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "308-398-8005",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}