{
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"OrgName": "LAKESIDE SENIOR CARE LLC",
"LastName": null,
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"FirstLineMailingAddress": "930 RIDGEBROOK RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPARKS",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21152-9390",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4306 24TH ST",
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"PracticeLocationAddressCityName": "LUBBOCK",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79410-1818",
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"PracticeLocationAddressTelephoneNumber": "806-793-2555",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/30/2009",
"LastUpdateDate": "04/30/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POWELL",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialTelephoneNumber": "806-793-2555",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}