{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "ANGEL'S INN",
"LastName": null,
"FirstName": null,
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"FirstLineMailingAddress": "518 PINE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WATERTOWN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13601-3235",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "518 PINE ST",
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"PracticeLocationAddressCityName": "WATERTOWN",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/26/2016",
"LastUpdateDate": "02/26/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRADLEY",
"AuthorizedOfficialFirstName": "FLOYD",
"AuthorizedOfficialMiddleName": "AUSTIN",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
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"AuthorizedOfficialCredential": "LHNA",
"AuthorizedOfficialTelephoneNumber": "315-782-2238",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "376G00000X",
"TaxonomyName": "Nursing Home Administrator",
"LicenseNumber": "05684",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "311ZA0620X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}