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General NPI Number Information
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NPI Number | 1487055448
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Entity Type | Organization
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Legal Business Name | MD ALF INC
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 15735 SW 303RD TER
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City | HOMESTEAD
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State | FL
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Zip | 33033-3457
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Country | US
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Telephone | 305-247-0260
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Fax |
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Provider Business Mailing Address
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Address Line | 15095 SW 155TH TER
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City | MIAMI
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State | FL
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Zip | 33187-0604
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Country | US
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Telephone | 305-238-3203
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Fax | 305-238-6258
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAVIS ADASSA DODDS
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Credential |
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Telephone | 305-322-1938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL8890
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License Number State | FL
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