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General NPI Number Information
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NPI Number | 1629119086
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Entity Type | Organization
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Legal Business Name | RAINROCK TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 41496 MCKENZIE HWY
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City | SPRINGFIELD
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State | OR
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Zip | 97478-8688
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Country | US
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Telephone | 541-896-9300
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Fax | 541-896-9300
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Provider Business Mailing Address
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Address Line | 6100 SW 76TH ST
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5002
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Country | US
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Telephone | 305-663-1876
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Fax | 786-359-4485
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. MIKE BAGLEY
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Credential |
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Telephone | 305-663-1876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 835
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License Number State | OR
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