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General NPI Number Information
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NPI Number | 1215125018
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Entity Type | Organization
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Legal Business Name | SHARED VISION RESIDENTIAL CARE INC.
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Dates
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Enumeration Date | 10/06/2007
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Last Update Date | 10/06/2007
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Provider Practice Location Address
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Address Line | 1339 W CHAVANEAUX RD
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City | SAN ANTONIO
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State | TX
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Zip | 78224-2607
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Country | US
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Telephone | 210-977-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 1339 W CHAVANEAUX RD
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City | SAN ANTONIO
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State | TX
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Zip | 78224-2607
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Country | US
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Telephone | 210-977-8900
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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 | DR. THOMAS JAMES ALLEN
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Credential | DDS
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Telephone | 210-977-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 873470
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License Number State | TX
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