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General NPI Number Information
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NPI Number | 1053334433
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Entity Type | Organization
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Legal Business Name | CARE SOURCE HOME HEALTH, LLC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 953 E SAHARA AVE F-17
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City | LAS VEGAS
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State | NV
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Zip | 89104-3005
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Country | US
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Telephone | 702-862-4050
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Fax | 702-862-4060
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Provider Business Mailing Address
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Address Line | 953 E SAHARA AVE STE F-17
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City | LAS VEGAS
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State | NV
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Zip | 89104-3005
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Country | US
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Telephone | 702-862-4050
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Fax | 702-862-4060
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DESIREE MAGCALAS
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Credential | RN
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Telephone | 818-448-4858
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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 | 412088A-1
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License Number State | NV
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