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General NPI Number Information
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NPI Number | 1013666304
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Entity Type | Organization
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Legal Business Name | ICAN GROUP LLC
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 911 E ORCHID LN
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City | CHANDLER
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State | AZ
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Zip | 85225-1406
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Country | US
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Telephone | 480-267-0358
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11716
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City | TEMPE
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State | AZ
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Zip | 85284-0029
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MOHAMED IMAM
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Credential | PHD
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Telephone | 480-267-0358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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