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General NPI Number Information
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NPI Number | 1144041328
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Entity Type | Organization
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Legal Business Name | SOLACE GROVE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 38685 GOOSE CREEK LN
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City | LEESBURG
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State | VA
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Zip | 20175-6642
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Country | US
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Telephone | 703-462-9141
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Fax |
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Provider Business Mailing Address
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Address Line | 1880 HOWARD AVE STE 301A
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City | VIENNA
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State | VA
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Zip | 22182-2611
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IBRAHIM JUMA
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Credential |
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Telephone | 814-423-0387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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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 | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #3
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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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