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General NPI Number Information
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NPI Number | 1316757123
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Entity Type | Organization
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Legal Business Name | POINTE SIDE OPCO LLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 4865 MAIN ST
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City | SPRINGFIELD
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State | OR
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Zip | 97478-6057
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Country | US
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Telephone | 541-284-2865
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Fax |
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Provider Business Mailing Address
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Address Line | 609 LAKEVIEW BLVD
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City | SANDPOINT
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State | ID
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Zip | 83864-1120
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Country | US
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Telephone | 503-706-6918
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TREVOR WART
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Credential |
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Telephone | 503-706-6918
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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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