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General NPI Number Information
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NPI Number | 1164931440
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Entity Type | Organization
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Legal Business Name | HOLISTIX OUTPATIENT CENTER
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 219 E HIGH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19144-1101
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Country | US
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Telephone | 561-676-2792
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Fax |
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Provider Business Mailing Address
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Address Line | 219 E HIGH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19144-1101
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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 | BILLING
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Name | IRENE MANKO
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Credential |
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Telephone | 561-676-2792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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