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General NPI Number Information
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NPI Number | 1114390101
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Entity Type | Organization
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Legal Business Name | WELLNESS CARE CENTER LLC
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 17633 MEADOWBRIDGE DR
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City | LUTZ
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State | FL
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Zip | 33549-5574
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Country | US
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Telephone | 857-234-0830
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Fax | 813-232-2127
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Provider Business Mailing Address
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Address Line | 17633 MEADOWBRIDGE DR
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City | LUTZ
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State | FL
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Zip | 33549-5574
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Country | US
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Telephone | 857-234-0830
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Fax | 813-232-2127
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. DAVID OLUWASOLA AINA
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Credential |
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Telephone | 857-234-0830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12626
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License Number State | FL
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