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General NPI Number Information
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NPI Number | 1124774260
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Entity Type | Organization
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Legal Business Name | REVERE CARE INC.
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 8064 N POINT BLVD STE 105
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3235
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Country | US
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Telephone | 336-760-8001
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Fax | 336-760-8030
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Provider Business Mailing Address
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Address Line | 8064 N POINT BLVD STE 105
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3235
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Country | US
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Telephone | 336-760-8001
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Fax | 336-760-8030
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Authorized Official
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Title or Position | FRANCHISE OWNER - CEO
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Name | MRS. DENISE BUSTOS
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Credential |
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Telephone | 336-760-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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