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General NPI Number Information
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NPI Number | 1073964417
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Entity Type | Organization
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Legal Business Name | LEGACY HEALTHCARE SERVICES INC.
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 1700 PAMALEE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-2824
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Country | US
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Telephone | 910-949-2096
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 SPRING FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27616-2815
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP HUMAN RESOURCES AND RECRUITMENT
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Name | JEFF FINK
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Credential |
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Telephone | 919-424-5080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 16045
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License Number State | NC
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