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General NPI Number Information
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NPI Number | 1215260880
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Entity Type | Organization
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Legal Business Name | CEDAR CREEK ASSISTED LIVING
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 156 WINSTON DRIVE
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City | PIKEVILLE
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State | KY
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Zip | 41501
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Country | US
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Telephone | 606-432-8243
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Fax | 606-433-9805
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Provider Business Mailing Address
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Address Line | P.O. BOX 18067
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City | LOUISVILLE
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State | KY
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Zip | 40261-0067
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Country | US
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Telephone | 502-259-9101
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Fax | 502-259-9109
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Authorized Official
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Title or Position | A/R MANAGER
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Name | MRS. LAVINIA A O'CONNOR
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Credential |
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Telephone | 502-259-9101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 20011109801
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License Number State | KY
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