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General NPI Number Information
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NPI Number | 1407141930
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Entity Type | Organization
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Legal Business Name | FOUNDATION HEALTHCARE LLC
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 929 CEDAR AVE
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City | SCRANTON
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State | PA
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Zip | 18505-1723
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Country | US
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Telephone | 570-955-3260
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Fax | 570-504-7278
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Provider Business Mailing Address
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Address Line | 201 S. BLAKELY ST. #176
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City | DUNMORE
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State | PA
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Zip | 18512
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Country | US
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Telephone | 570-955-3260
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Fax | 570-504-7278
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONALD A. HALKO
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Credential | OWNER
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Telephone | 215-718-9702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 357038
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | PA
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