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General NPI Number Information
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NPI Number | 1669549887
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Entity Type | Organization
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Legal Business Name | PROVIDE CARE, INC.
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 4722 ISANTI TRL
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City | NORTH BRANCH
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State | MN
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Zip | 55056-5420
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Country | US
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Telephone | 651-674-8312
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Fax | 651-674-8299
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Provider Business Mailing Address
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Address Line | PO BOX 538
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City | NORTH BRANCH
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State | MN
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Zip | 55056-0538
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Country | US
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Telephone | 651-674-8312
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Fax | 651-674-8299
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Authorized Official
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Title or Position | COMPTROLLER
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Name | SUSAN KAY ROD
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Credential |
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Telephone | 651-674-8312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 045822800
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License Number State | MN
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