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General NPI Number Information
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NPI Number | 1235675059
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Entity Type | Organization
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Legal Business Name | HOME CARE SPECIALITY LLC
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 901 TWELVE OAKS CENTER DR # 914
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City | WAYZATA
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State | MN
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Zip | 55391-4701
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Country | US
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Telephone | 763-302-9930
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Fax |
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Provider Business Mailing Address
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Address Line | 901 TWELVE OAKS CENTER DR STE 914
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City | WAYZATA
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State | MN
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Zip | 55391-4710
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Country | US
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Telephone | 763-302-9930
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAMELLA BWARI ONYAMBU
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Credential |
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Telephone | 763-302-9930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 379624
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License Number State | MN
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