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General NPI Number Information
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NPI Number | 1497164404
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Entity Type | Organization
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Legal Business Name | DE QUEEN THERAPY & LIVING CENTER, INC.
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 322 W COLLIN RAYE DR
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City | DE QUEEN
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State | AR
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Zip | 71832-2007
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Country | US
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Telephone | 870-642-3562
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 S WALDRON RD
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City | FORT SMITH
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State | AR
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Zip | 72903-2583
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Country | US
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Telephone | 479-434-5500
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Fax | 479-434-5526
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSHUA ALLEN KILGORE
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Credential |
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Telephone | 479-434-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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