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General NPI Number Information
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NPI Number | 1003104738
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Entity Type | Organization
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Legal Business Name | BROWARD LIFECARE, LLC
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 777 SE 20TH ST STE 255
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-3591
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Country | US
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Telephone | 774-223-3459
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Fax | 774-223-3465
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Provider Business Mailing Address
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Address Line | 4820 SW 161ST LN
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City | MIRAMAR
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State | FL
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Zip | 33027-4935
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Country | US
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Telephone | 774-223-3459
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Fax | 774-223-3465
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. ANGELO SOCHUK
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Credential | CSA
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Telephone | 774-223-3459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 232250
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License Number State | FL
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