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General NPI Number Information
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NPI Number | 1285458976
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Entity Type | Organization
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Legal Business Name | LOTUS ASSISTED LIVING FACILITY INC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1477 SW GOODMAN AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-1418
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Country | US
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Telephone | 561-628-0832
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Fax |
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Provider Business Mailing Address
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Address Line | 4077 MANOR FOREST TRL
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-8850
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Country | US
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Telephone | 561-628-0832
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MURA DARABAN
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Credential |
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Telephone | 561-628-0832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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