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General NPI Number Information
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NPI Number | 1265680045
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Entity Type | Organization
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Legal Business Name | LAUREL GROVE ACUTE HOSPITAL
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 19933 LAKE CHABOT RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4003
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Country | US
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Telephone | 510-537-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 3012 SUMMIT ST 4TH FLOOR
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City | OAKLAND
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State | CA
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Zip | 94609-3480
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Country | US
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Telephone | 510-869-6591
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Fax | 510-869-6592
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Authorized Official
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Title or Position | REGIONAL DIRECTOR - PFS
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Name | MR. GEORGE DERBEDROSIAN
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Credential |
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Telephone | 510-869-6163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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