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General NPI Number Information
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NPI Number | 1013511153
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Entity Type | Organization
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Legal Business Name | EXCEPTIONAL PROVIDER SERVICE, LLC
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 8546 BROADWAY STE 206
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City | SAN ANTONIO
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State | TX
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Zip | 78217-6340
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Country | US
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Telephone | 210-579-0223
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Fax | 210-579-0242
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Provider Business Mailing Address
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Address Line | PO BOX 632
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City | LEMING
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State | TX
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Zip | 78050-0632
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Country | US
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Telephone | 210-579-0223
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Fax | 210-579-0242
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | DANIEL CASTILLO
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Credential |
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Telephone | 210-579-0223
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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 |
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License Number State |
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