{
"Npi": {
"NPI": "1932789781",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHERN PINES RETIREMENT VILLA",
"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": "345 PERRY HWY.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAWKINSVILLE",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31036",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-783-3445",
"MailingAddressFaxNumber": "478-783-3545",
"FirstLinePracticeLocationAddress": "345 PERRY HWY.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAWKINSVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31036",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-783-3445",
"PracticeLocationAddressFaxNumber": "478-783-3545",
"EnumerationDate": "04/14/2021",
"LastUpdateDate": "04/08/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RICHARDSON",
"AuthorizedOfficialFirstName": "SANDRA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MISS",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "478-279-3286",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "311Z00000X",
"TaxonomyName": "Custodial Care Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}