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General NPI Number Information
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NPI Number | 1447570627
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Entity Type | Organization
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Legal Business Name | SENC DIRECT CARE
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 663 SE BAYA
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City | LAKE CITY
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State | FL
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Zip | 32055
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Country | US
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Telephone | 786-953-2521
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Fax |
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Provider Business Mailing Address
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Address Line | 747 NW BRADY CIR
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City | LAKE CITY
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State | FL
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Zip | 32055-6143
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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 | MANAGER
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Name | MR. CEDRIC CRAY
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Credential |
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Telephone | 786-953-2521
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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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