{
"Npi": {
"NPI": "1912451980",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EXCELLENCE ASSISTED LIVING FACILITY, LLC",
"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": "5950 LAKEHURST DR STE 182",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORLANDO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32819-8363",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-930-9290",
"MailingAddressFaxNumber": "407-930-9380",
"FirstLinePracticeLocationAddress": "2250 S SEMORAN BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ORLANDO",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32822-2704",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-930-9291",
"PracticeLocationAddressFaxNumber": "407-930-9381",
"EnumerationDate": "08/08/2016",
"LastUpdateDate": "08/08/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PORTIGLIATTI",
"AuthorizedOfficialFirstName": "BRUNO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "407-930-9290",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "AL12850",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}