{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RAINTREE HEALTHCARE OF TABOR CITY, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 668611",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHARLOTTE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28266-8611",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-653-6400",
"MailingAddressFaxNumber": "803-631-3939",
"FirstLinePracticeLocationAddress": "703 ELIZABETH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TABOR CITY",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28463-2603",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-653-6400",
"PracticeLocationAddressFaxNumber": "910-653-5081",
"EnumerationDate": "01/09/2008",
"LastUpdateDate": "01/09/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OWENS",
"AuthorizedOfficialFirstName": "REEMA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MS.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "704-763-6300",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "HAL024010",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}