{
"Npi": {
"NPI": "1528340528",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "IMMANUEL RETIREMENT COMMUNITIES, INC.",
"ParentOrgTIN": null,
"OrgName": "IMMANUEL RETIREMENT COMMUNITIES",
"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": "1044 N 115TH ST",
"SecondLineMailingAddress": "SUITE 500",
"MailingAddressCityName": "OMAHA",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68154-4425",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-829-2943",
"MailingAddressFaxNumber": "402-829-2998",
"FirstLinePracticeLocationAddress": "522 W LINCOLN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PAPILLION",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68046-3121",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-614-5500",
"PracticeLocationAddressFaxNumber": "402-614-5503",
"EnumerationDate": "09/15/2011",
"LastUpdateDate": "11/29/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GURLEY",
"AuthorizedOfficialFirstName": "ERIC",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "402-829-2943",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "ALF088",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}