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General NPI Number Information
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NPI Number | 1194252338
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Entity Type | Organization
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Legal Business Name | MAJESTICAL CARE
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Dates
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Enumeration Date | 05/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4701 BASELINE RD
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City | LITTLE ROCK
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State | AR
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Zip | 72209-5205
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Country | US
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Telephone | 501-569-9907
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Fax | 501-569-9977
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Provider Business Mailing Address
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Address Line | 4701 BASELINE RD
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City | LITTLE ROCK
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State | AR
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Zip | 72209-5205
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Country | US
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Telephone | 501-569-9907
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Fax | 501-569-9977
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Authorized Official
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Title or Position | OWNER
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Name | DONTA WADE
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Credential |
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Telephone | 501-563-8960
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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 | AR5157
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License Number State |
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