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General NPI Number Information
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NPI Number | 1629004395
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Entity Type | Organization
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Legal Business Name | AVON CONVALESCENT HOME, INC.
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 652 W AVON RD
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City | AVON
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State | CT
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Zip | 06001-2906
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Country | US
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Telephone | 860-673-2521
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Fax | 860-675-1587
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Provider Business Mailing Address
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Address Line | 652 W AVON RD
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City | AVON
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State | CT
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Zip | 06001-2906
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Country | US
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Telephone | 860-673-2521
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Fax | 860-675-1587
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Authorized Official
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Title or Position | V.P. / DIRECTOR OF OPERATION
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Name | MR. RUSSELL SCHWARTZ
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Credential |
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Telephone | 860-490-9855
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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 | 938-C
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License Number State | CT
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