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General NPI Number Information
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NPI Number | 1316726094
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Entity Type | Organization
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Legal Business Name | OUR HOUSE OF FAVOR
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 1546 BERRY BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40215-1955
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Country | US
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Telephone | 502-912-2689
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Fax |
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Provider Business Mailing Address
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Address Line | 135 SHADOW ROCK CT
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City | SHEPHERDSVILLE
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State | KY
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Zip | 40165-4607
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAYBAH GLAY
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Credential |
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Telephone | 502-689-2830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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