{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FORDYCE ASSISTED LIVING INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1718 INDUSTRIAL DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORDYCE",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "71742",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "870-890-2408",
"MailingAddressFaxNumber": "870-890-2420",
"FirstLinePracticeLocationAddress": "1718 INDUSTRIAL DR",
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"PracticeLocationAddressCityName": "FORDYCE",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "71074",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "870-890-2412",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/07/2014",
"LastUpdateDate": "07/07/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TENBROOK",
"AuthorizedOfficialFirstName": "CARLA",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MISS",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "479-394-3200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "097",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}