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General NPI Number Information
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NPI Number | 1114577640
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Entity Type | Organization
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Legal Business Name | JUANA CARE FACILITY
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 389 JUANA AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4810
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Country | US
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Telephone | 510-357-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 4487 MOUNTAIN VIEW AVE
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City | OAKLAND
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State | CA
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Zip | 94605-1209
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Country | US
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Telephone | 510-504-1788
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENE ADRINA LEVINE
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Credential |
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Telephone | 510-504-1788
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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 |
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License Number State |
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