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General NPI Number Information
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NPI Number | 1396907663
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Entity Type | Organization
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Legal Business Name | HARVEST MOON INTERMEDIATE CARE FACILITY- NURSING
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 1017 E HARVEST MOON ST
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City | WEST COVINA
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State | CA
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Zip | 91792-1023
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Country | US
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Telephone | 626-961-0076
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Fax | 626-961-0076
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Provider Business Mailing Address
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Address Line | 1017 E HARVEST MOON ST
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City | WEST COVINA
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State | CA
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Zip | 91792-1023
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Country | US
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Telephone | 626-961-0076
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Fax | 626-961-0076
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. YOLIE CRUME
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Credential | RN
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Telephone | 626-551-7379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 960001418
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License Number State | CA
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