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General NPI Number Information
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NPI Number | 1467483362
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Entity Type | Organization
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Legal Business Name | CONCHO VALLEY HHC OF WEST TX LLC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 430 W BEAUREGARD AVE STE B
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City | SAN ANGELO
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State | TX
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Zip | 76903
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Country | US
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Telephone | 235-944-8916
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Fax | 325-944-8929
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Provider Business Mailing Address
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Address Line | PO BOX 3247
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City | SAN ANGELO
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State | TX
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Zip | 76902-3247
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Country | US
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Telephone | 235-944-8916
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Fax | 325-944-8929
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LOUISE TOWNSEND
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Credential |
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Telephone | 325-944-8916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 008619
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License Number State | TX
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