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General NPI Number Information
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NPI Number | 1194043968
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Entity Type | Organization
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Legal Business Name | SEED CENTER ROSWELL REHABILITATION ADDICTION PROGRAM
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 1659 WASHINGTON BLVD
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City | KANSAS CITY
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State | KS
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Zip | 66102-2841
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Country | US
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Telephone | 913-233-2223
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Fax |
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Provider Business Mailing Address
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Address Line | 1659 WASHINGTON BLVD
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City | KANSAS CITY
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State | KS
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Zip | 66102-2841
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Country | US
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Telephone | 913-233-2223
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. ALAN D PORTER
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Credential | MSW
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Telephone | 573-823-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number | 07070894
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License Number State | KS
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