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General NPI Number Information
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NPI Number | 1013887033
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Entity Type | Organization
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Legal Business Name | BLUE FOUNTAIN I HOME CARE, LLC
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 190 ENTERPRISE AVE SE
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City | PALM BAY
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State | FL
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Zip | 32909-3968
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Country | US
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Telephone | 954-559-3265
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Fax | 321-914-4069
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Provider Business Mailing Address
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Address Line | 2440 EMERSON DR SE
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City | PALM BAY
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State | FL
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Zip | 32909-4972
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Country | US
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Telephone | 954-559-3265
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Fax | 321-914-4069
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LANDRY FRANCOIS
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Credential |
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Telephone | 954-668-3006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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