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General NPI Number Information
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NPI Number | 1144093907
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Entity Type | Organization
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Legal Business Name | CONVERGENCE ADULT CARE
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 5931 NW 173RD DR STE 7-8
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City | HIALEAH
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State | FL
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Zip | 33015-5106
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Country | US
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Telephone | 786-838-2375
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Fax |
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Provider Business Mailing Address
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Address Line | 12356 NW 97TH CT
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City | HIALEAH
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State | FL
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Zip | 33018-2952
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Country | US
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Telephone | 786-838-2375
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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. SEBNA LEON
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Credential |
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Telephone | 786-838-2375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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