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General NPI Number Information
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NPI Number | 1306096649
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Entity Type | Organization
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Legal Business Name | PHOENIX ASPIRATION SYSTEM OF CARE LLC
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 2710 ELM AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23704-7013
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Country | US
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Telephone | 757-393-5850
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Fax | 757-393-5853
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Provider Business Mailing Address
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Address Line | 2710 ELM AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23704-7013
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Country | US
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Telephone | 757-393-5850
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Fax | 757-393-5853
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSEPH M. HECTOR
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Credential |
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Telephone | 757-393-5850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 731-01-001
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License Number State | VA
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