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General NPI Number Information
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NPI Number | 1538647896
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Entity Type | Organization
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Legal Business Name | WALDEN HEALTHCARE, LLC.
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 25200 CENTER RIDGE RD STE 2301
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City | WESTLAKE
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State | OH
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Zip | 44145-4141
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Country | US
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Telephone | 440-455-3348
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Fax | 440-895-5050
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Provider Business Mailing Address
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Address Line | 36711 AMERICAN WAY STE A
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City | AVON
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State | OH
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Zip | 44011-4062
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Country | US
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Telephone | 440-455-3348
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Fax | 440-895-5050
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | JENNIFER HOLOWACH
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Credential |
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Telephone | 718-614-7624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.047318
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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