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General NPI Number Information
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NPI Number | 1063706661
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Entity Type | Organization
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Legal Business Name | ALLIANCE FAMILY SERVICES NORTH, INC.
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 1101 W MOANA LN
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City | RENO
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State | NV
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Zip | 89509-4775
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Country | US
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Telephone | 208-265-5049
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Fax |
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Provider Business Mailing Address
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Address Line | 608 S DIVISION AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1749
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Country | US
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Telephone | 208-265-5049
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MR. DEREK J RICHEY
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Credential |
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Telephone | 208-265-5049
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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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