{
"Npi": {
"NPI": "1528152600",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MERCY SERVICES FOR AGING NONPROFIT HOUSING CORPORATION",
"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": "PO BOX 9184",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FARMINGTON HILLS",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48333-9184",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-542-8300",
"MailingAddressFaxNumber": "734-542-8384",
"FirstLinePracticeLocationAddress": "873 W AVON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROCHESTER HILLS",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48307-2705",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-656-3239",
"PracticeLocationAddressFaxNumber": "248-656-3269",
"EnumerationDate": "10/03/2006",
"LastUpdateDate": "09/11/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LATOVICK",
"AuthorizedOfficialFirstName": "PAMELA",
"AuthorizedOfficialMiddleName": "SUE",
"AuthorizedOfficialTitle": "VICE PRESIDENT REIMBURSEMENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "734-343-6628",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "634018",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}