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General NPI Number Information
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NPI Number | 1003108556
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Entity Type | Organization
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Legal Business Name | SOLID ROCK FOUNDATION CENTER, LLC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 1288 KEY WEST AVE
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City | MIZPAH
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State | NJ
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Zip | 08342
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Country | US
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Telephone | 609-616-2166
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Fax |
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Provider Business Mailing Address
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Address Line | 1288 KEY WEST AVE
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City | MIZPAH
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State | NJ
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Zip | 08342
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Country | US
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Telephone | 609-616-2166
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Fax |
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Authorized Official
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Title or Position | MSW, OWNER
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Name | ETHEL GAYLORD
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Credential |
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Telephone | 609-616-2166
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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 | 1633550
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License Number State | NJ
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