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General NPI Number Information
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NPI Number | 1174896807
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Entity Type | Organization
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Legal Business Name | MCGREGOR HOME CARMICHAEL
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 5712 LOCUST AVE
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City | CARMICHAEL
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State | CA
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Zip | 95608-1321
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Country | US
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Telephone | 916-971-9958
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Fax | 916-467-7282
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Provider Business Mailing Address
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Address Line | 5712 LOCUST AVE
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City | CARMICHAEL
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State | CA
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Zip | 95608-1321
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Country | US
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Telephone | 916-971-9958
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Fax | 916-467-7282
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Authorized Official
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Title or Position | ADMINISTRATOR/LICENSEE
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Name | MRS. HEIDI REMEDIOS SANTOS ARANA
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Credential |
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Telephone | 916-873-4197
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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 | 347004109
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License Number State | CA
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