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General NPI Number Information
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NPI Number | 1629252994
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Entity Type | Organization
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Legal Business Name | QUALICARE INC.
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 3539 BRIAR CREEK LN SUITE A
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City | AMMON
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State | ID
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Zip | 83406-4761
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Country | US
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Telephone | 208-542-1388
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Fax | 208-552-7847
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Provider Business Mailing Address
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Address Line | 3539 BRIAR CREEK LN SUITE A
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City | AMMON
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State | ID
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Zip | 83406-4761
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Country | US
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Telephone | 208-542-1388
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Fax | 208-552-7847
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | BART O LARSEN
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Credential | LSW
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Telephone | 208-542-1388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | C132647
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License Number State | ID
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