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General NPI Number Information
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NPI Number | 1043265887
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Entity Type | Organization
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Legal Business Name | LIFE FOUNTAIN HEALTH CARE, INC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 1115 NEW HALLS FERRY RD 202
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City | SAINT LOUIS
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State | MO
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Zip | 63033
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Country | US
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Telephone | 314-830-3840
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Fax | 314-830-3820
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Provider Business Mailing Address
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Address Line | 11115 NEW HALLS FERRY RD 202
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City | FLORISSANT
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State | MO
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Zip | 63033-7613
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Country | US
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Telephone | 314-830-3840
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Fax | 314-830-3820
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Authorized Official
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Title or Position | OWNER
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Name | MR. ADEGBOLA ADEJISOLA ADEGOKE
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Credential |
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Telephone | 314-454-6865
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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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