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General NPI Number Information
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NPI Number | 1689246795
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Entity Type | Organization
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Legal Business Name | ABSOLUTE CARE LLC
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 07/16/2021
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Provider Practice Location Address
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Address Line | 3842 E IRWIN AVE
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City | MESA
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State | AZ
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Zip | 85206-3852
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Country | US
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Telephone | 602-394-2689
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Fax |
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Provider Business Mailing Address
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Address Line | 3842 E IRWIN AVE
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City | MESA
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State | AZ
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Zip | 85206-3852
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR - CNL
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Name | DR. RANDY MALLARI
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Credential | OMD, MSN, BA, RN
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Telephone | 602-888-2468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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