{
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"IsOrgSubpart": "N",
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"OrgName": "ELY EXTENDED CARE INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 187",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLASGOW",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "42142-0187",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "270-479-0340",
"MailingAddressFaxNumber": "270-629-5769",
"FirstLinePracticeLocationAddress": "109 MORAN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLASGOW",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "42141-1632",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "270-479-0340",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/19/2019",
"LastUpdateDate": "12/02/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ENNIS",
"AuthorizedOfficialFirstName": "LASHELLE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR OF PHARMACY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "270-479-0340",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}