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General NPI Number Information
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NPI Number | 1548706732
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Entity Type | Organization
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Legal Business Name | SR DREAM HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 01/11/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 8190 BARKER CYPRESS RD #1900-301
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City | CYPRESS
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State | TX
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Zip | 77433-1223
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Country | US
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Telephone | 832-952-0065
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Fax |
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Provider Business Mailing Address
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Address Line | 8190 BARKER CYPRESS RD #1900-301
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City | CYPRESS
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State | TX
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Zip | 77433-1223
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Country | US
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Telephone | 832-952-0065
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Fax |
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Authorized Official
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Title or Position | ALTERNATE ADMINISTRATOR
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Name | MR. RALPHEAL NEKEY MATCHETT
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Credential |
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Telephone | 832-952-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 017779
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License Number State | TX
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