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General NPI Number Information
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NPI Number | 1144501560
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Entity Type | Organization
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Legal Business Name | REJUVENATE HEALTH CARE CENTER LLC
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 3900 NW 79TH AVE STE 102
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City | DORAL
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State | FL
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Zip | 33166-6545
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Country | US
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Telephone | 305-593-2227
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 NW 79TH AVE STE 102
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City | DORAL
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State | FL
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Zip | 33166-6545
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Country | US
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Telephone | 305-593-2227
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LUIS ALONZO JR.
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Credential | OTR
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Telephone | 305-593-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | OT 12543
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License Number State | FL
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