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General NPI Number Information
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NPI Number | 1184774291
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Entity Type | Organization
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Legal Business Name | ANGELWINGS COORDINATED CARE LLC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | HC 61, BOX 416 QUAIL DRIVE
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City | GLENWOOD
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State | NM
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Zip | 88039
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Country | US
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Telephone | 505-539-2227
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Fax | 505-539-2225
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Provider Business Mailing Address
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Address Line | HC 61, BOX 416 QUAIL DRIVE
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City | GLENWOOD
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State | NM
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Zip | 88039
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Country | US
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Telephone | 505-539-2227
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Fax | 505-539-2225
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Authorized Official
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Title or Position | OWNER
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Name | SHARON L BEATY
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Credential |
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Telephone | 505-539-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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