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General NPI Number Information
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NPI Number | 1609874163
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Entity Type | Organization
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Legal Business Name | COVENANT CARE CAPITOLA, LLC
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 1935 WHARF RD
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City | CAPITOLA
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State | CA
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Zip | 95010-2606
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Country | US
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Telephone | 831-476-0770
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Fax | 831-476-0737
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Provider Business Mailing Address
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Address Line | 1935 WHARF RD
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City | CAPITOLA
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State | CA
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Zip | 95010-2606
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Country | US
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Telephone | 831-476-0770
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Fax | 831-476-0737
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Authorized Official
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Title or Position | DIRECTOR OF REIMBURSEMENT
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Name | CAROL A SPARKS
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Credential |
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Telephone | 949-349-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 070000039
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License Number State | CA
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