{
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"NPI": "1730690538",
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "CSL HAVERHILL SENIOR PROPERTIES, LLC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "1584 CHARLOTTE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NAPERVILLE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60564-8204",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "312-401-2118",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2939 S HAVERHILL RD",
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"PracticeLocationAddressCityName": "HAVERHILL",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33415-8118",
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"PracticeLocationAddressTelephoneNumber": "561-612-2415",
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"EnumerationDate": "10/19/2017",
"LastUpdateDate": "10/19/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BENNEMA",
"AuthorizedOfficialFirstName": "KEVEN",
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"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "312-401-2118",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Nursing Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}