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General NPI Number Information
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NPI Number | 1396149811
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Entity Type | Organization
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Legal Business Name | SIGNATURE HOME CARE, LLC
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 11775 W JOBLANCA RD
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City | AVONDALE
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State | AZ
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Zip | 85323-6241
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Country | US
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Telephone | 478-607-1052
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Fax |
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Provider Business Mailing Address
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Address Line | 14050 W VAN BUREN ST # 154
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City | GOODYEAR
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State | AZ
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Zip | 85338-1228
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JEREMY LAWRENCE
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Credential |
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Telephone | 478-607-1052
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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 | 90655
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License Number State | AZ
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