{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "LIFE STAGES ASSISTED LIVING LLC",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 3066",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARTINSVILLE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24115-3066",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-330-8683",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "424 GLOVENIA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EDEN",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27288-4844",
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"PracticeLocationAddressTelephoneNumber": "336-623-1093",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/21/2015",
"LastUpdateDate": "10/26/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MORRIS",
"AuthorizedOfficialFirstName": "TOREY",
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"AuthorizedOfficialTitle": "ADMINISTRATOR",
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"AuthorizedOfficialTelephoneNumber": "732-330-8683",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "FCL-079-100",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}