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General NPI Number Information
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NPI Number | 1609927268
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Entity Type | Organization
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Legal Business Name | AMADA ENTERPRISES INC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 12619 S AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90061-2727
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Country | US
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Telephone | 323-757-1881
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Fax | 323-905-0980
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Provider Business Mailing Address
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Address Line | 12619 S AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90061-2727
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Country | US
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Telephone | 323-757-1881
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Fax | 323-905-0980
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOHN E JONES
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Credential | RPH, MBA, NHA
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Telephone | 323-757-1881
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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 | 056417
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License Number State | CA
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