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General NPI Number Information
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NPI Number | 1043655079
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Entity Type | Organization
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Legal Business Name | HERNANDO ENTERPRISE,INC.
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 300 71ST ST STE 400
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City | MIAMI BEACH
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State | FL
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Zip | 33141-3092
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Country | US
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Telephone | 305-868-1830
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Fax | 305-868-2304
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Provider Business Mailing Address
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Address Line | 5701 S PLEASANT GROVE RD
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City | INVERNESS
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State | FL
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Zip | 34452-8385
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Country | US
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Telephone | 352-726-2555
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Fax | 352-726-7011
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. POLLY SHEPPARD
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Credential |
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Telephone | 352-726-2555
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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 | AL10113
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License Number State | FL
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