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General NPI Number Information
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NPI Number | 1629582663
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Entity Type | Organization
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Legal Business Name | MY RESIDENCE CARE PLACE LLC
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 10175 COUNTY ROAD 229
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City | OXFORD
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State | FL
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Zip | 34484-3955
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Country | US
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Telephone | 352-484-5495
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Fax | 352-330-0621
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Provider Business Mailing Address
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Address Line | 10175 COUNTY ROAD 229
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City | OXFORD
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State | FL
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Zip | 34484-3955
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Country | US
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Telephone | 352-484-5495
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Fax | 352-330-0621
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Authorized Official
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Title or Position | OWNER
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Name | KIM RICHELLE JONES
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Credential |
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Telephone | 352-484-5495
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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 | 234865
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License Number State | FL
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