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General NPI Number Information
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NPI Number | 1447164371
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Entity Type | Organization
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Legal Business Name | ACTIVE RESIDENTIAL LLC
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 700 RAY O VAC DR STE 2
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City | MADISON
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State | WI
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Zip | 53711-2469
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Country | US
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Telephone | 608-282-5061
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Fax |
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Provider Business Mailing Address
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Address Line | 700 RAY O VAC DR STE 2 002
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City | MADISON
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State | WI
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Zip | 53711-2469
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Country | US
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Telephone | 608-282-5061
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABDISALAN H MUHUMED
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Credential |
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Telephone | 608-282-5061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State | NULL
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