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General NPI Number Information
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NPI Number | 1104287291
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE GROUP
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 10057 LINCOLN RD
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City | CAMP DENNISON
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State | OH
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Zip | 45111-9736
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Country | US
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Telephone | 513-502-3212
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Fax | 513-332-4433
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Provider Business Mailing Address
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Address Line | 10057 LINCOLN RD
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City | CAMP DENNISON
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State | OH
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Zip | 45111-9736
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Country | US
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Telephone | 513-502-3212
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Fax | 513-332-4433
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. REED ISSAC HAMILTON
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Credential |
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Telephone | 513-502-3212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 201532300126
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License Number State | OH
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