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General NPI Number Information
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NPI Number | 1104303411
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Entity Type | Organization
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Legal Business Name | BROOKYS HAVEN
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 217 JONES ST APT 215
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City | SHREVEPORT
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State | LA
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Zip | 71101-4060
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Country | US
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Telephone | 131-842-3136
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Fax |
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Provider Business Mailing Address
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Address Line | 217 JONES ST APT 215
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City | SHREVEPORT
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State | LA
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Zip | 71101-4060
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Country | US
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Telephone | 131-842-3136
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANE WILLIAMS
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Credential |
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Telephone | 318-423-1367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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