{
"Npi": {
"NPI": "1841424900",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIBERTYVILLE MANOR",
"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": "1007 JENKISSON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKE BLUFF",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60044-1623",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-234-9467",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "610 PETERSON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LIBERTYVILLE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60048-1014",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "847-367-6100",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/05/2009",
"LastUpdateDate": "05/05/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STOKAVICH",
"AuthorizedOfficialFirstName": "MILAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "847-367-6100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "160000723",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}