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General NPI Number Information
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NPI Number | 1447069679
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Entity Type | Organization
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Legal Business Name | SOCAL RESPITE LLC
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 6327 GIOVANNI WAY
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City | PALMDALE
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State | CA
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Zip | 93551-1616
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Country | US
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Telephone | 909-896-4539
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Fax |
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Provider Business Mailing Address
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Address Line | 16604 TIMBERVIEW AVE
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City | CHINO HILLS
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State | CA
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Zip | 91709-7844
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Country | US
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Telephone | 626-806-6655
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MAXMILLAN DE LOS SANTOS
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Credential |
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Telephone | 626-806-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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