{
"Npi": {
"NPI": "1720239619",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GLENWOOD HEALTHCARE, LLC",
"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": "PO BOX 612",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JESUP",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31598-0612",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-523-5102",
"MailingAddressFaxNumber": "912-523-5704",
"FirstLinePracticeLocationAddress": "41 N FIFTH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLENWOOD",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30428-0869",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "912-523-5102",
"PracticeLocationAddressFaxNumber": "912-523-5704",
"EnumerationDate": "10/09/2008",
"LastUpdateDate": "12/19/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TOLSON",
"AuthorizedOfficialFirstName": "TERRY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "404-644-0471",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}