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General NPI Number Information
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NPI Number | 1356634745
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Entity Type | Organization
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Legal Business Name | OUR HOUSE ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 8248 MIMICO S
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City | MILLERSVILLE
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State | MD
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Zip | 21108-1145
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Country | US
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Telephone | 410-987-2046
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Fax |
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Provider Business Mailing Address
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Address Line | 8248 MIMICO S
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City | MILLERSVILLE
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State | MD
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Zip | 21108-1145
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Country | US
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Telephone | 410-987-2046
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. JACQUELINE D MASON
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Credential |
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Telephone | 443-205-7543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 02AL0299
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License Number State | MD
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