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General NPI Number Information
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NPI Number | 1174136915
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Entity Type | Organization
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Legal Business Name | MAGNOLIA ANGELS HEALTHCARE STAFFING LLC
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Dates
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Enumeration Date | 08/30/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 635 E 106TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46280-1329
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Country | US
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Telephone | 317-220-8499
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Fax |
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Provider Business Mailing Address
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Address Line | 635 E 106TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46280-1329
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Country | US
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Telephone | 317-220-8499
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MYKESHIA TAYLOR
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Credential |
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Telephone | 317-688-8204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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