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General NPI Number Information
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NPI Number | 1255756714
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Entity Type | Organization
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Legal Business Name | ANGELIC HEART AT HOME CARE
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 3022 JAVIER RD STE 207A
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City | FAIRFAX
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State | VA
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Zip | 22031-4657
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Country | US
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Telephone | 703-560-6100
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Fax | 703-560-6101
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Provider Business Mailing Address
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Address Line | 3022 JAVIER RD STE 207A
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City | FAIRFAX
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State | VA
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Zip | 22031-4657
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Country | US
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Telephone | 703-560-6100
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Fax | 703-560-6101
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Authorized Official
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Title or Position | ADMINISTRATOR/PRESIDENT
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Name | CLOTILDE FLORES
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Credential |
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Telephone | 571-330-6228
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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 |
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License Number State | VA
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