{
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"EIN": null,
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"OrgName": "EXTENSIONS OF LIVING, L.L.C.",
"LastName": null,
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"FirstLineMailingAddress": "4939 BRAGG BLVD",
"SecondLineMailingAddress": "SUITE #202",
"MailingAddressCityName": "FAYETTEVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28303-3686",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-485-8370",
"MailingAddressFaxNumber": "252-514-2770",
"FirstLinePracticeLocationAddress": "4939 BRAGG BLVD",
"SecondLinePracticeLocationAddress": "SUITE #202",
"PracticeLocationAddressCityName": "FAYETTEVILLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-485-8370",
"PracticeLocationAddressFaxNumber": "252-514-2770",
"EnumerationDate": "04/17/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROBINSON",
"AuthorizedOfficialFirstName": "MONIQUE",
"AuthorizedOfficialMiddleName": "ALEXANDRIA",
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"AuthorizedOfficialNamePrefix": null,
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"AuthorizedOfficialCredential": "ADMINISTRATOR",
"AuthorizedOfficialTelephoneNumber": "252-514-2727",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Home Health Agency",
"LicenseNumber": "HC3021",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}