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General NPI Number Information
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NPI Number | 1225671035
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Entity Type | Organization
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Legal Business Name | GRACEFUL CARE MANAGEMENT LLC
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 01/03/2021
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Provider Practice Location Address
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Address Line | 203 NACOGDOCHES ST STE 360
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2454
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Country | US
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Telephone | 903-586-3505
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1766
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City | JACKSONVILLE
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State | TX
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Zip | 75766-1766
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Country | US
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Telephone | 903-586-3505
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STACY MCCOWN
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Credential | FNP-C
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Telephone | 903-586-3505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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