{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "PRESBYTERIAN MANOR, INC.",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4600 TAFT BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WICHITA FALLS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76308-4935",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "940-691-1710",
"MailingAddressFaxNumber": "940-691-3742",
"FirstLinePracticeLocationAddress": "4600 TAFT BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WICHITA FALLS",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "940-691-1710",
"PracticeLocationAddressFaxNumber": "940-691-3742",
"EnumerationDate": "04/02/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OAKLEY",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "JAMES",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "940-691-1710",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": "000143",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}