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General NPI Number Information
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NPI Number | 1205395654
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Entity Type | Organization
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Legal Business Name | CC REHAB
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 502 S LEROY ST
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City | FENTON
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State | MI
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Zip | 48430-2252
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Country | US
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Telephone | 810-444-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 39000 CHASE ST
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City | ROMULUS
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State | MI
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Zip | 48174-1303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHARLENE COMBS
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Credential | OTR/L
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Telephone | 840-444-5555
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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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