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General NPI Number Information
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NPI Number | 1477971448
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Entity Type | Organization
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Legal Business Name | PROMISE ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 1231 S ALVARADO ST
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City | LOS ANGELES
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State | CA
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Zip | 90006-4119
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Country | US
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Telephone | 310-205-2591
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Fax | 310-205-2596
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Provider Business Mailing Address
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Address Line | 1231 S ALVARADO ST
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City | LOS ANGELES
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State | CA
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Zip | 90006-4119
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Country | US
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Telephone | 310-205-2591
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Fax | 310-205-2596
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Authorized Official
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Title or Position | CEO
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Name | MR. ZULFICAR GREGORY RESTUM
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Credential |
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Telephone | 310-205-2591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 197608604
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License Number State | CA
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