{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "DELAND MANOR ASSISTED LIVING CORP",
"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "245 S AMELIA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DELAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32724-5913",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "386-624-7777",
"MailingAddressFaxNumber": "386-279-7341",
"FirstLinePracticeLocationAddress": "245 S. AMELIA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DELAND",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "386-624-7777",
"PracticeLocationAddressFaxNumber": "386-279-7341",
"EnumerationDate": "09/21/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JAVIER",
"AuthorizedOfficialFirstName": "DENNIS",
"AuthorizedOfficialMiddleName": "FABIAN",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "407-453-6541",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "AL12944",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}