{
"Npi": {
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"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SENIOR LIVING OF LAKEWOOD, LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7900 WESTPARK DR",
"SecondLineMailingAddress": "T-900 ATTN: MEDICARE BILLING, M. GARCIA",
"MailingAddressCityName": "MC LEAN",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22102-4242",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-854-0823",
"MailingAddressFaxNumber": "703-854-0164",
"FirstLinePracticeLocationAddress": "12791 W ALAMEDA PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKEWOOD",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80228-2857",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-237-5700",
"PracticeLocationAddressFaxNumber": "303-237-5850",
"EnumerationDate": "04/19/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RICHARD",
"AuthorizedOfficialFirstName": "JUNE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "303-237-5700",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "0878",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}