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General NPI Number Information
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NPI Number | 1609456458
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 10250 SW 56TH ST STE D103
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City | MIAMI
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State | FL
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Zip | 33165-7065
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Country | US
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Telephone | 305-220-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 10250 SW 56TH ST STE D103
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City | MIAMI
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State | FL
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Zip | 33165-7065
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Country | US
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Telephone | 305-220-1088
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NERCY B RADCLIFFE
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Credential |
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Telephone | 305-220-1088
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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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