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General NPI Number Information
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NPI Number | 1518572973
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Entity Type | Organization
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Legal Business Name | ENCHANTED HEARTS HOME CARE SERVICES LLC.
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Dates
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Enumeration Date | 09/12/2020
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 119 DAVIS RD STE 5C
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City | MARTINEZ
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State | GA
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Zip | 30907-0217
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Country | US
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Telephone | 706-799-3017
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Fax | 706-925-5723
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Provider Business Mailing Address
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Address Line | PO BOX 9373
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City | AUGUSTA
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State | GA
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Zip | 30916-9373
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Country | US
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Telephone | 706-799-3017
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | QUANISHA ALIYAH VERA
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Credential |
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Telephone | 706-910-3580
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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 |
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License Number State |
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