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General NPI Number Information
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NPI Number | 1295131720
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Entity Type | Organization
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Legal Business Name | MEDLIFE ACTIVITY CENTER, LLC
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Dates
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Enumeration Date | 11/11/2014
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Last Update Date | 11/11/2014
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Provider Practice Location Address
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Address Line | 900 W 49TH ST SUITE 500
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City | HIALEAH
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State | FL
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Zip | 33012-3402
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Country | US
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Telephone | 305-588-0570
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Fax | 786-837-2902
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Provider Business Mailing Address
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Address Line | 900 W 49TH ST SUITE 500
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City | HIALEAH
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State | FL
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Zip | 33012-3402
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Country | US
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Telephone | 305-588-0570
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Fax | 786-837-2902
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CELIA M LOPEZ
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Credential |
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Telephone | 305-588-0570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9296
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License Number State | FL
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