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General NPI Number Information
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NPI Number | 1578863817
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Entity Type | Organization
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Legal Business Name | DIVINE VISION SUPPORT SERVICES, INC.
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 1010 E ADAMS ST 227
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City | JACKSONVILLE
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State | FL
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Zip | 32202-1902
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Country | US
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Telephone | 904-396-6745
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Fax | 888-398-0944
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Provider Business Mailing Address
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Address Line | 1010 E ADAMS ST 227
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City | JACKSONVILLE
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State | FL
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Zip | 32202
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Country | US
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Telephone | 904-396-6745
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Fax | 888-398-0944
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CARRIE LEE GARRETT
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Credential |
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Telephone | 904-398-7645
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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 | 1000014359
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License Number State | FL
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