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General NPI Number Information
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NPI Number | 1043913346
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Entity Type | Organization
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Legal Business Name | AGING WITH GRACE AT HOME LLC
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 2501 27TH AVE STE A2
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City | VERO BEACH
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State | FL
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Zip | 32960-1952
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Country | US
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Telephone | 772-770-1400
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Fax | 772-999-2961
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Provider Business Mailing Address
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Address Line | 2501 27TH AVE STE A2
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City | VERO BEACH
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State | FL
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Zip | 32960-1952
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Country | US
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Telephone | 772-770-1400
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Fax | 772-999-2961
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Authorized Official
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Title or Position | AMBR
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Name | TIFFANY TRIPSON
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Credential |
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Telephone | 772-473-0443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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