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General NPI Number Information
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NPI Number | 1417035346
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Entity Type | Organization
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Legal Business Name | COUNTRY VIEW CARE HOME
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 1060 W FM 462
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City | MOORE
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State | TX
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Zip | 78057-3505
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Country | US
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Telephone | 830-665-6068
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Fax | 830-663-5232
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Provider Business Mailing Address
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Address Line | PO BOX 186
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City | MOORE
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State | TX
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Zip | 78057-0186
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Country | US
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Telephone | 830-665-6068
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Fax | 830-663-5232
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Authorized Official
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Title or Position | OWNER
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Name | RHONDA L KORCZYNSKI
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Credential |
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Telephone | 830-665-6068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 000716
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License Number State | TX
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