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General NPI Number Information
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NPI Number | 1548624695
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Entity Type | Organization
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Legal Business Name | SUMMIT HEALTHCARE ORGANIZATION - BAY AREA, LLC
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 39899 BALENTINE DR SUITE 314
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City | NEWARK
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State | CA
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Zip | 94560-5366
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Country | US
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Telephone | 510-573-2415
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Fax | 888-875-0832
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Provider Business Mailing Address
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Address Line | 39899 BALENTINE DR SUITE 314
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City | NEWARK
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State | CA
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Zip | 94560-5366
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Country | US
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Telephone | 510-573-2415
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Fax | 888-875-0832
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JONATHAN BLISS
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Credential |
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Telephone | 408-609-0245
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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 | 550003065
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License Number State | CA
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