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General NPI Number Information
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NPI Number | 1235277260
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Entity Type | Organization
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Legal Business Name | PROVIDENCE CARE
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 891 NOELL LN
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-1742
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Country | US
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Telephone | 252-443-7144
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Fax | 252-443-2319
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Provider Business Mailing Address
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Address Line | 891 NOELL LN
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-1742
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Country | US
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Telephone | 252-443-7144
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Fax | 252-443-2319
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Authorized Official
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Title or Position | ADMINISTRATOROWNER
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Name | DEBORAH RICE REDGRAVE
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Credential |
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Telephone | 252-443-7144
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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 | HAL064016
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License Number State | NC
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