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General NPI Number Information
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NPI Number | 1083191027
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Entity Type | Organization
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Legal Business Name | M & C FOSTER CARE HOME LLC
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 3093 WOOLSEY PL
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City | HONOLULU
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State | HI
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Zip | 96822-1569
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Country | US
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Telephone | 509-619-5836
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Fax | 808-988-6452
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Provider Business Mailing Address
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Address Line | 3093 WOOLSEY PL
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City | HONOLULU
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State | HI
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Zip | 96822-1569
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Country | US
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Telephone | 509-619-5836
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Fax | 808-988-6452
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MIKI MANANSALA
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Credential |
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Telephone | 509-619-5836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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