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General NPI Number Information
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NPI Number | 1093903130
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Entity Type | Organization
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Legal Business Name | SPARC
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 845 CENTRAL AVE
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City | ALBANY
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State | NY
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Zip | 12206-1514
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Country | US
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Telephone | 518-482-2455
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Fax |
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Provider Business Mailing Address
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Address Line | 845 CENTRAL AVE
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City | ALBANY
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State | NY
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Zip | 12206-1514
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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 | CEO
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Name | STEVE BOYLE
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Credential |
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Telephone | 515-525-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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