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General NPI Number Information
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NPI Number | 1609946920
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Entity Type | Organization
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Legal Business Name | ST. JOHNLAND NURSING CENTER, INC.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 395 SUNKEN MEADOW RD
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City | KINGS PARK
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State | NY
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Zip | 11754-1000
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Country | US
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Telephone | 631-269-5800
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Fax | 631-269-5876
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Provider Business Mailing Address
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Address Line | 395 SUNKEN MEADOW RD
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City | KINGS PARK
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State | NY
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Zip | 11754-1000
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Country | US
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Telephone | 631-269-5800
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Fax | 631-269-5876
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Authorized Official
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Title or Position | CEO - ADMINISTRATOR
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Name | MRS. MARY JEAN WEBER
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Credential | LNHA
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Telephone | 631-269-5800
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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 | 5157902L
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License Number State | NY
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