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General NPI Number Information
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NPI Number | 1376043505
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Entity Type | Organization
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Legal Business Name | ULTIMATE HEALTHCARE LLC
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 1583 W 18TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-4866
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Country | US
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Telephone | 904-234-1982
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12305
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City | JACKSONVILLE
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State | FL
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Zip | 32209-0305
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Country | US
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Telephone | 904-234-1982
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. MARSHA MILLER
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Credential | LPN
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Telephone | 904-234-1982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | PN1316831
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License Number State | FL
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