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General NPI Number Information
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NPI Number | 1437410891
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Entity Type | Organization
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Legal Business Name | MADO HEALTHCARE
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 1541 NORTH WELLS
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City | CHICAGO
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State | IL
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Zip | 60610-1307
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Country | US
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Telephone | 312-787-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 1541 NORTH WELLS
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City | CHICAGO
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State | IL
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Zip | 60610-1307
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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 | DEVELOPMENT DIRECTOR
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Name | MARK MROZ
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Credential |
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Telephone | 312-399-4193
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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