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General NPI Number Information
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NPI Number | 1073844031
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Entity Type | Organization
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Legal Business Name | DEVINE DESTINY ASSISTED LIVING
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 16427 W WATKINS ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-9713
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Country | US
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Telephone | 623-882-8144
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Fax |
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Provider Business Mailing Address
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Address Line | 16427 W WATKINS ST
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City | GOODYEAR
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State | AZ
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Zip | 85338-9713
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Country | US
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Telephone | 623-882-8144
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID OHANIAN
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Credential |
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Telephone | 623-693-4750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL7558H
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License Number State | AZ
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