{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "OLIVE MOUNTAIN RESIDENTIAL CARE LLC",
"LastName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 969",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LEBANON",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "65536-0969",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "417-532-3045",
"MailingAddressFaxNumber": "417-532-4104",
"FirstLinePracticeLocationAddress": "25466 N HWY 5",
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"PracticeLocationAddressCityName": "LEBANON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "417-532-3045",
"PracticeLocationAddressFaxNumber": "417-532-4104",
"EnumerationDate": "07/06/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "UPTON",
"AuthorizedOfficialFirstName": "STEPHANIE",
"AuthorizedOfficialMiddleName": "NICHOLE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "417-532-3045",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "033209",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}