{
"Npi": {
"NPI": "1669919387",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIFETIME SERENITY ASSISTED LIVING",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3304 MENLO DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BALTIMORE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21215-3826",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-358-4401",
"MailingAddressFaxNumber": "410-358-4402",
"FirstLinePracticeLocationAddress": "8507 LIBERTY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RANDALLSTOWN",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21133-4833",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-496-9105",
"PracticeLocationAddressFaxNumber": "410-496-9109",
"EnumerationDate": "01/20/2017",
"LastUpdateDate": "01/20/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARKES",
"AuthorizedOfficialFirstName": "DONOVAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "410-428-1382",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "30AL3431-A",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}