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General NPI Number Information
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NPI Number | 1386970846
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Entity Type | Organization
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Legal Business Name | INDIVIDUALIZED SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 1965 42ND AVE STE 3
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City | VERO BEACH
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State | FL
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Zip | 32960-2502
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Country | US
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Telephone | 772-492-9159
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Fax | 772-492-9147
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Provider Business Mailing Address
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Address Line | 234 SW STARFLOWER AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-4461
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Country | US
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Telephone | 772-696-3189
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Fax | 772-492-9147
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Authorized Official
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Title or Position | ONER
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Name | RENA ARLENE BAKER
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Credential |
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Telephone | 772-696-3189
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 001173600
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License Number State | FL
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