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General NPI Number Information
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NPI Number | 1073757423
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Entity Type | Organization
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Legal Business Name | PROVIDENT CARE MANAGEMENT
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 6412 N UNIVERSITY DR SUITE 120
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City | TAMARAC
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State | FL
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Zip | 33321-4055
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Country | US
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Telephone | 954-726-7267
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Fax | 954-726-7776
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Provider Business Mailing Address
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Address Line | 6412 NORTH UNIVERSITY DRIVE SUITE 120
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City | TAMARAC
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State | FL
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Zip | 33321-5568
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Country | US
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Telephone | 954-726-7267
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Fax | 954-726-7776
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LORI E. KOBETZ
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Credential |
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Telephone | 954-294-5244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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