{
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"IsOrgSubpart": "N",
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"NamePrefix": null,
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"FirstLineMailingAddress": "1002 BELL RIDGE CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROCKWELL",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28138-7437",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-239-2199",
"MailingAddressFaxNumber": "704-856-8196",
"FirstLinePracticeLocationAddress": "1345 CHAPMAN LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEWTON",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28658-1778",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "828-464-6490",
"PracticeLocationAddressFaxNumber": "828-466-3002",
"EnumerationDate": "07/14/2020",
"LastUpdateDate": "07/14/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLACK",
"AuthorizedOfficialFirstName": "CASEY",
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"AuthorizedOfficialTitle": "MEMBER MANGER/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "704-239-2199",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}