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General NPI Number Information
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NPI Number | 1598298473
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Entity Type | Organization
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Legal Business Name | PROMISE HOME CARE LLC
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 1133 LOUISIANA AVE STE 114
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City | WINTER PARK
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State | FL
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Zip | 32789-2350
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Country | US
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Telephone | 407-986-1140
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Fax | 407-986-6050
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Provider Business Mailing Address
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Address Line | 1133 LOUISIANA AVE SUITE 114
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City | WINTER PARK
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State | FL
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Zip | 32789
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Country | US
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Telephone | 407-986-1140
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Fax | 407-986-6050
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Authorized Official
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Title or Position | CEO & OWNER
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Name | MR. DAVID MATTHEW CLITES
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Credential |
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Telephone | 407-986-1140
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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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