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General NPI Number Information
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NPI Number | 1669607651
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Entity Type | Organization
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Legal Business Name | IMMANUEL HOSPICE, INC.
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 482 W. ARROW HWY SUITE G
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City | SAN DIMAS
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State | CA
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Zip | 91773-2960
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Country | US
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Telephone | 909-592-4834
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Fax | 909-592-1708
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Provider Business Mailing Address
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Address Line | 482 W. ARROW HWY SUITE G
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City | SAN DIMAS
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State | CA
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Zip | 91773-2960
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Country | US
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Telephone | 909-592-4834
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Fax | 909-592-1708
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL L. FOLKES
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Credential |
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Telephone | 909-592-4834
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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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