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General NPI Number Information
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NPI Number | 1003296377
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Entity Type | Organization
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Legal Business Name | HOME DIALYSIS SERVICES HERSHEY LLC
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 555 E CHOCOLATE AVE SUITE 102
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City | HERSHEY
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State | PA
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Zip | 17033-1334
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Country | US
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Telephone | 717-500-5177
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Fax | 717-500-5179
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Provider Business Mailing Address
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Address Line | PO BOX 3134
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City | JOLIET
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State | IL
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Zip | 60434-3134
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Country | US
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Telephone | 815-741-6830
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Fax | 815-741-6832
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MORUFU ALAUSA
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Credential | M.D.
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Telephone | 815-741-6830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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