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General NPI Number Information
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NPI Number | 1083837637
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Entity Type | Organization
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Legal Business Name | PROVIDE A CARE LLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 500 E HIGGINS RD SUITE 207
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-1400
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Country | US
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Telephone | 773-326-6860
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Fax | 847-690-1539
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Provider Business Mailing Address
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Address Line | 500 E HIGGINS RD SUITE 207
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-1400
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Country | US
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Telephone | 773-326-6860
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Fax | 847-690-1539
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Authorized Official
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Title or Position | DIRECTOR
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Name | CARMENCITA AGNO
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Credential | RN
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Telephone | 773-326-6860
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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 | 1010653
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License Number State | IL
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