{
"Npi": {
"NPI": "1790489920",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE WINCHESTER ASSISTED LIVING & RESPITE HOME 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": "3089 WINCHESTER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST BLOOMFIELD",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48322-2411",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-970-2922",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3089 WINCHESTER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST BLOOMFIELD",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48322-2411",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-970-2922",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/30/2023",
"LastUpdateDate": "03/30/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GILLESPIE",
"AuthorizedOfficialFirstName": "EUGENE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "LICENSEE DESIGNEE",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "313-820-5548",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3104A0625X",
"TaxonomyName": "Assisted Living Facility (Mental Illness)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "320800000X",
"TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "253Z00000X",
"TaxonomyName": "In Home Supportive Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}