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General NPI Number Information
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NPI Number | 1548904063
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Entity Type | Organization
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Legal Business Name | SHIRLEY WILSON HEAVENLY HEALTHCARE
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 5105 BENNING RD
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City | JACKSONVILLE
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State | FL
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Zip | 32254-3610
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Country | US
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Telephone | 904-667-7962
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Fax | 904-580-5805
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Provider Business Mailing Address
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Address Line | 5105 BENNING RD
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City | JACKSONVILLE
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State | FL
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Zip | 32254-3610
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Country | US
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Telephone | 904-487-3949
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHIRLEY CRAWFORD WILSON
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Credential | OWNER
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Telephone | 904-487-3949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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