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General NPI Number Information
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NPI Number | 1215919949
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Entity Type | Organization
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Legal Business Name | THOMAS REST HAVEN
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 217 MAIN ST
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City | COON RAPIDS
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State | IA
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Zip | 50058-1605
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Country | US
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Telephone | 712-999-2253
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Fax | 712-999-5669
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Provider Business Mailing Address
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Address Line | 217 MAIN ST
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City | COON RAPIDS
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State | IA
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Zip | 50058-1605
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Country | US
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Telephone | 712-999-2253
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Fax | 712-999-5669
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY JANE VENTEICHER
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Credential |
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Telephone | 712-999-2253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 140430
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 140430
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License Number State | IA
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