{
"Npi": {
"NPI": "1851440309",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STONERIDGE HEALTH AND REHAB CENTER",
"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": "1051 LANTRIP RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHERWOOD",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72120-4161",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-833-5627",
"MailingAddressFaxNumber": "501-835-6905",
"FirstLinePracticeLocationAddress": "4017 FRANKLIN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLLEGE STATION",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72053",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-490-1533",
"PracticeLocationAddressFaxNumber": "501-490-0608",
"EnumerationDate": "01/10/2007",
"LastUpdateDate": "12/09/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LUTH",
"AuthorizedOfficialFirstName": "KURT",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "REGISTERED AGENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "501-833-5627",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": "0798",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}