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General NPI Number Information
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NPI Number | 1548680473
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Entity Type | Organization
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Legal Business Name | MEDANGEL HEALTHCARE, LLC
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 9245 LAGUNA SPRINGS DR SUITE 200
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City | ELK GROVE
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State | CA
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Zip | 95758-7987
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Country | US
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Telephone | 916-509-7068
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 661528
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City | SACRAMENTO
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State | CA
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Zip | 95866-1528
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Country | US
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Telephone | 916-509-7068
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GABRIEL MCCREA
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Credential |
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Telephone | 916-509-7068
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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 | 5000002158
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License Number State | CA
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