{
"Npi": {
"NPI": "1952584757",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MADISONVILLE II ENTERPRISES, LLC",
"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": "4150 INTERNATIONAL PLAZA",
"SecondLineMailingAddress": "SUITE 600",
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76109-4831",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-348-8959",
"MailingAddressFaxNumber": "817-348-0466",
"FirstLinePracticeLocationAddress": "411 E. COLLARD ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MADISONVILLE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77864-3306",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "936-348-2735",
"PracticeLocationAddressFaxNumber": "936-348-6401",
"EnumerationDate": "12/14/2007",
"LastUpdateDate": "04/13/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLAKE",
"AuthorizedOfficialFirstName": "GARY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGING MEMBER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "817-348-8959",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}