{
"Npi": {
"NPI": "1760104889",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CLEARSKY REHABILITATION HOSPITAL OF KENOSHA LLC",
"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": "5600 WYOMING BLVD NE STE 225",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALBUQUERQUE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87109-3136",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-317-3802",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6308 8TH AVE",
"SecondLinePracticeLocationAddress": "PALMER TOWER",
"PracticeLocationAddressCityName": "KENOSHA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53143-5031",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-771-0073",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/15/2022",
"LastUpdateDate": "02/22/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DUNCAN",
"AuthorizedOfficialFirstName": "KRISTI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "505-317-3988",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "283X00000X",
"TaxonomyName": "Rehabilitation Hospital",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}