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General NPI Number Information
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NPI Number | 1003328733
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Entity Type | Organization
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Legal Business Name | SPIRIT CARE SERVICES INC
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 11/03/2017
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Provider Practice Location Address
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Address Line | 9925 HIGHWAY 178
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-3213
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Country | US
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Telephone | 901-292-8494
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Fax | 662-932-2278
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Provider Business Mailing Address
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Address Line | 6717 BRANCH RD S
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-4377
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Country | US
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Telephone | 901-292-8494
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Fax | 662-893-2278
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Authorized Official
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Title or Position | OWNER
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Name | RAY SHAWN JOHNSON
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Credential |
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Telephone | 901-292-8494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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