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General NPI Number Information
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NPI Number | 1497093801
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Entity Type | Organization
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Legal Business Name | ANGEL OF LIFE LLC
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 2057 W 64TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90047-1702
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Country | US
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Telephone | 323-365-9117
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Fax | 323-570-0386
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Provider Business Mailing Address
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Address Line | PO BOX 431571
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City | LOS ANGELES
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State | CA
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Zip | 90043-9571
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Country | US
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Telephone | 323-365-9117
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Fax | 323-570-0386
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Authorized Official
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Title or Position | OWNER, ADMINISTRATOR
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Name | MS. LETRICIA L. BROWN
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Credential |
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Telephone | 323-365-9117
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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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