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General NPI Number Information
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NPI Number | 1568659977
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Entity Type | Organization
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Legal Business Name | POWAY ADULT DAY HEALTH CARE CENTER LLC
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Dates
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Enumeration Date | 09/29/2007
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Last Update Date | 09/29/2007
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Provider Practice Location Address
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Address Line | 13180 POWAY RD
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City | POWAY
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State | CA
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Zip | 92064-4612
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Country | US
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Telephone | 858-748-5044
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Fax | 858-748-5405
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Provider Business Mailing Address
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Address Line | 10923 CAMINITO TIERRA
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City | SAN DIEGO
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State | CA
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Zip | 92131-3569
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Country | US
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Telephone | 858-748-5044
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Fax | 858-748-5405
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. KATHRYN FAYE HOLT
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Credential | B.A., M.A.
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Telephone | 858-748-5044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | CA
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