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General NPI Number Information
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NPI Number | 1275665424
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Entity Type | Organization
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Legal Business Name | MIRACLE OF FAITH FAMILY CARE
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 1413 CLIFFWOOD DR
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City | GREENSBORO
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State | NC
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Zip | 27406-4108
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Country | US
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Telephone | 336-987-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 CLIFFWOOD DR
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City | GREENSBORO
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State | NC
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Zip | 27406-4108
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Country | US
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Telephone | 336-987-5333
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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. CAROLYN LEE CONNOR
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Credential |
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Telephone | 336-987-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | MHL-041-791
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License Number State | NC
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