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General NPI Number Information
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NPI Number | 1275939811
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Entity Type | Organization
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Legal Business Name | MOICANO HEALTHCARE PROVIDER LLC
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 260 NORTHLAND BLVD STE 320
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City | SPRINGDALE
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State | OH
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Zip | 45246-4921
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Country | US
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Telephone | 513-580-3109
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Fax | 513-818-9594
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Provider Business Mailing Address
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Address Line | 260 NORTHLAND BLVD STE 320
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City | SPRINGDALE
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State | OH
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Zip | 45246-4921
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Country | US
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Telephone | 513-580-3109
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Fax | 513-818-9594
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Authorized Official
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Title or Position | CEO
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Name | DR. CALEB N LOLA I
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Credential | DODD
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Telephone | 18006176733
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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 | 2264980
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License Number State | OH
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