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General NPI Number Information
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NPI Number | 1639353881
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Entity Type | Organization
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Legal Business Name | SERENITY MEADOWS CARE CENTER CORPORATION
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 12/24/2007
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Provider Practice Location Address
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Address Line | 2300 CAMP DR APT 1103
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City | MIDLAND
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State | TX
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Zip | 79701-2005
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Country | US
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Telephone | 682-561-3889
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Fax | 432-756-2904
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Provider Business Mailing Address
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Address Line | 2300 CAMP DR APT 1103
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City | MIDLAND
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State | TX
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Zip | 79701-2005
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Country | US
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Telephone | 682-561-3889
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Fax | 432-756-2904
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. TEIZO DEVOTNAE ADKISON
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Credential | LVN
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Telephone | 682-561-3889
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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 |
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License Number State |
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