{
"Npi": {
"NPI": "1801847702",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PREMIER HEALTHCARE MANAGEMENT OF LONG PRAIRIE LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "20 9TH ST SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LONG PRAIRIE",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "56347-1404",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": "320-764-2300",
"FirstLinePracticeLocationAddress": "20 SE NINTH STREET",
"SecondLinePracticeLocationAddress": "CENTRA CARE HEALTH SYSTEM- LONG PRAIRE",
"PracticeLocationAddressCityName": "LONG PRAIRIE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "56347-1404",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "320-732-2141",
"PracticeLocationAddressFaxNumber": "320-732-3802",
"EnumerationDate": "05/15/2006",
"LastUpdateDate": "06/14/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STRUZYK",
"AuthorizedOfficialFirstName": "FRED",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SEC/TREASURER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "320-764-1503",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "331051",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}