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General NPI Number Information
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NPI Number | 1619143682
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Entity Type | Organization
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Legal Business Name | ANDREA CAINE
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1580 DRAYTON AVE
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City | DELTONA
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State | FL
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Zip | 32725-5671
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Country | US
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Telephone | 386-532-2392
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 DRAYTON AVE
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City | DELTONA
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State | FL
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Zip | 32725-5671
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Country | US
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Telephone | 386-532-2392
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MS. ANDREA MARIE CAINE
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Credential | LPN
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Telephone | 386-532-2392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11140
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License Number State | FL
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