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General NPI Number Information
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NPI Number | 1053650523
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Entity Type | Organization
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Legal Business Name | SHELLEY BRUCE ENTERPRISES, INC.
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 95 INDIAN TRAIL RD
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City | KALISPELL
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State | MT
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Zip | 59901-2613
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Country | US
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Telephone | 406-755-4030
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Fax | 406-755-1070
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Provider Business Mailing Address
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Address Line | 95 INDIAN TRAIL RD
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City | KALISPELL
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State | MT
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Zip | 59901-2613
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Country | US
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Telephone | 406-755-4030
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Fax | 406-755-1070
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Authorized Official
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Title or Position | OWNER
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Name | SHELLEY BRUCE
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Credential | OWNER
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Telephone | 406-249-8438
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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 | MT
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