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General NPI Number Information
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NPI Number | 1396095089
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Entity Type | Organization
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Legal Business Name | HEALING HANDS HOME HEALTHCARE, LLC
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 5854 ENRIGHT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63112-2302
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Country | US
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Telephone | 314-574-9560
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Fax |
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Provider Business Mailing Address
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Address Line | 2919 ORIENTAL DR
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City | FLORISSANT
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State | MO
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Zip | 63031-1447
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Country | US
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Telephone | 314-541-9485
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Fax |
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Authorized Official
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Title or Position | FIREMAN
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Name | MR. RODERICK STUART WILSON JR.
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Credential |
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Telephone | 314-574-9560
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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 | 193200000X
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License Number State | MO
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