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General NPI Number Information
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NPI Number | 1588329015
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Entity Type | Organization
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Legal Business Name | HAVENCOVE
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Dates
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Enumeration Date | 10/31/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 16154 W DEVONSHIRE AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-6445
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Country | US
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Telephone | 213-357-1299
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Fax |
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Provider Business Mailing Address
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Address Line | 15196 W WESTVIEW DR
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City | GOODYEAR
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State | AZ
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Zip | 85395-8290
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OFFICER
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Name | DR. ALAELDIN MOHAMED
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Credential | PHARM.D
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Telephone | 402-968-5295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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