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General NPI Number Information
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NPI Number | 1659429389
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Entity Type | Organization
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Legal Business Name | KC1
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 317 W JEFFERSON ST
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City | BUTLER
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State | PA
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Zip | 16001-6921
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Country | US
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Telephone | 724-284-0076
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Fax | 724-284-9729
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Provider Business Mailing Address
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Address Line | 226 W NEW CASTLE ST
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City | BUTLER
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State | PA
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Zip | 16001-5254
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Country | US
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Telephone | 724-284-0076
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Fax | 724-284-9729
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL CARINGOLA
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Credential |
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Telephone | 724-284-0076
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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 | 415990
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License Number State | PA
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