{
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"EIN": null,
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"IsOrgSubpart": "Y",
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"ParentOrgTIN": null,
"OrgName": "CRAIGSIDE RETIREMENT RESIDENCE",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15 CRAIGSIDE PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HONOLULU",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96817-1799",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-523-7000",
"MailingAddressFaxNumber": "808-440-0026",
"FirstLinePracticeLocationAddress": "15 CRAIGSIDE PL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HONOLULU",
"PracticeLocationAddressStateName": "HI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-523-7000",
"PracticeLocationAddressFaxNumber": "808-533-5497",
"EnumerationDate": "11/04/2011",
"LastUpdateDate": "02/27/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHITE",
"AuthorizedOfficialFirstName": "EMMET",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "808-983-1823",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": "79-N",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}