{
"Npi": {
"NPI": "1992958474",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SKYLAND MANOR PCH",
"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": "22546 MURDOCK AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "QUEENS VILLAGE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11429-2729",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-269-9764",
"MailingAddressFaxNumber": "718-465-1813",
"FirstLinePracticeLocationAddress": "3505 SKYLAND DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOGANVILLE",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30052-8962",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "770-985-3400",
"PracticeLocationAddressFaxNumber": "770-985-3425",
"EnumerationDate": "10/29/2008",
"LastUpdateDate": "10/29/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREENIDGE",
"AuthorizedOfficialFirstName": "HUGH",
"AuthorizedOfficialMiddleName": "HENDERSON",
"AuthorizedOfficialTitle": "MEMBER/MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "646-269-9764",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "061-01-329-1",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}