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General NPI Number Information
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NPI Number | 1376708123
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Entity Type | Organization
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Legal Business Name | ACTIVE HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 2116 45TH ST
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City | HIGHLAND
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State | IN
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Zip | 46322-3742
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Country | US
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Telephone | 219-922-0814
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Fax | 219-922-0652
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Provider Business Mailing Address
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Address Line | 2116 45TH ST
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City | HIGHLAND
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State | IN
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Zip | 46322-3742
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Country | US
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Telephone | 219-922-0814
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Fax | 219-922-0652
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Authorized Official
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Title or Position | ADMINISTRATOR, DIRECTOR OF NURSING
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Name | MRS. ROSITA CANONO
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Credential | BSN, RN
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Telephone | 219-922-0814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 08-006656-1
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License Number State | IN
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