{
"Npi": {
"NPI": "1619354073",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PALMETTO FACILITY 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": "4302 HOLLYWOOD BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOLLYWOOD",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33021-6635",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6750 W 22ND CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HIALEAH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33016-3918",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-843-0600",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/05/2015",
"LastUpdateDate": "05/05/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLEICH",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "AUTHORIZED REPRESENTATIVE",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "845-641-8314",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "SNF1424096",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}