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General NPI Number Information
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NPI Number | 1285176008
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Entity Type | Organization
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Legal Business Name | ANGEL CITY HOSPICE CARE INC
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 17777 CENTER COURT DR N SUITE 250
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City | CERRITOS
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State | CA
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Zip | 90703-9320
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Country | US
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Telephone | 562-860-0100
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Fax | 562-402-5090
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Provider Business Mailing Address
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Address Line | 17777 CENTER COURT DR N SUITE 250
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City | CERRITOS
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State | CA
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Zip | 90703-9320
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Country | US
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Telephone | 562-860-0100
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Fax | 562-402-5090
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Authorized Official
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Title or Position | OWNER
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Name | JONE JADE A BAUTISTA
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Credential |
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Telephone | 562-860-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 550001001
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License Number State | CA
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