{
"Npi": {
"NPI": "1609866235",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KEMPER COUNTY LTC INC",
"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": "PO BOX 577",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DE KALB",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39328-0577",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-743-5888",
"MailingAddressFaxNumber": "601-743-4506",
"FirstLinePracticeLocationAddress": "220 WILLOW AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DEKALB",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39328-0577",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-743-5888",
"PracticeLocationAddressFaxNumber": "601-743-4506",
"EnumerationDate": "10/25/2005",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NESTER",
"AuthorizedOfficialFirstName": "PATTY",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NHA",
"AuthorizedOfficialTelephoneNumber": "601-743-5888",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "358",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}