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General NPI Number Information
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NPI Number | 1558489872
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Entity Type | Organization
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Legal Business Name | HEAVENLY CARE FACILITY
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4420 C PKWY
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City | SACRAMENTO
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State | CA
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Zip | 95823-3010
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Country | US
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Telephone | 916-826-5817
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Fax | 916-424-7520
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Provider Business Mailing Address
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Address Line | 4540 FLORIN RD SUITE 373
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City | SACRAMENTO
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State | CA
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Zip | 95823-2536
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Country | US
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Telephone | 916-826-5817
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Fax | 916-424-7520
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MRS. KEASHA T WALTON ELLIS
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Credential |
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Telephone | 916-275-4567
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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 |
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License Number State |
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