{
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"OrgName": "425 CEDARCREST ROAD OPERATING COMPANY, LP",
"LastName": null,
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"FirstLineMailingAddress": "500 SENECA ST STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BUFFALO",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14204-1963",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-361-6636",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "425 CEDAR CREST DR",
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"PracticeLocationAddressCityName": "QUAKERTOWN",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressTelephoneNumber": "215-804-0736",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/11/2011",
"LastUpdateDate": "09/23/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KENWORTHY",
"AuthorizedOfficialFirstName": "KIMBERLY",
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"AuthorizedOfficialTitle": "SR. DIRECTOR REVENUE CYCLE MGMT",
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"AuthorizedOfficialTelephoneNumber": "716-361-6636",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251J00000X",
"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": "136710",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}