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General NPI Number Information
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NPI Number | 1659736460
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Entity Type | Organization
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Legal Business Name | MAGNOLIA HOSPICE OF THE DELTA, LLC
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 12120 COLONEL GLENN RD SUITE 10,000
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City | LITTLE ROCK
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State | AR
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Zip | 72210-2824
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Country | US
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Telephone | 870-540-0727
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Fax |
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Provider Business Mailing Address
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Address Line | 12120 COLONEL GLENN RD SUITE 10,000
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City | LITTLE ROCK
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State | AR
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Zip | 72210-2824
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Country | US
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Telephone | 870-540-0727
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | MRS. ERIN BOLTON
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Credential |
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Telephone | 870-540-0727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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