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General NPI Number Information
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NPI Number | 1598011710
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Entity Type | Organization
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Legal Business Name | PINE HILLS HEALTH CENTER, LLC
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 144 FM 1252 W
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City | KILGORE
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State | TX
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Zip | 75662-5093
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Country | US
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Telephone | 903-984-5688
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Fax | 903-984-8010
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Provider Business Mailing Address
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Address Line | 1523 TEXAS AVE
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City | BASTROP
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State | LA
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Zip | 71220-4043
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Country | US
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Telephone | 318-281-0078
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Fax | 318-281-2753
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. CHARLES G GLADNEY
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Credential |
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Telephone | 318-281-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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