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General NPI Number Information
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NPI Number | 1548206907
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Entity Type | Organization
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Legal Business Name | EVEREST LONG TERM CARE, LLC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 3315 FAITH CHURCH RD
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-9300
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Country | US
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Telephone | 704-882-3420
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Fax | 704-882-5197
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Provider Business Mailing Address
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Address Line | PO BOX 2518
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-2518
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Country | US
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Telephone | 704-882-3420
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Fax | 704-882-5197
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KAREN G MCDANIEL
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Credential |
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Telephone | 252-523-9094
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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 | NH0592
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License Number State | NC
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