{
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"LastName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9 SOMERSET AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVERSIDE",
"MailingAddressStateName": "RI",
"MailingAddressPostalCode": "02915-2432",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "401-368-1920",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "655 COMMONWEALTH AVE",
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"PracticeLocationAddressCityName": "WARWICK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "401-298-6986",
"PracticeLocationAddressFaxNumber": "401-889-3670",
"EnumerationDate": "06/08/2018",
"LastUpdateDate": "06/08/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLOUGHBY",
"AuthorizedOfficialFirstName": "AMANDA",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "401-298-6986",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "ALR1493",
"LicenseNumberStateCode": "RI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}