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General NPI Number Information
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NPI Number | 1356508667
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Entity Type | Organization
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Legal Business Name | VILLA FELICIANA MEDICAL COMPLEX
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 5002 HWY 10
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City | JACKSON
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State | LA
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Zip | 70748-0438
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Country | US
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Telephone | 225-634-4017
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 438
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City | JACKSON
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State | LA
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Zip | 70748-0438
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Country | US
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Telephone | 225-634-4017
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Fax |
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Authorized Official
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Title or Position | LONG TERM CARE ADMIN
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Name | MR. JAMES R O REAR
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Credential |
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Telephone | 225-634-4017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 233
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License Number State | LA
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