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General NPI Number Information
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NPI Number | 1689829053
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Entity Type | Organization
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Legal Business Name | SULLIVAN CENTER, INC
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Dates
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Enumeration Date | 11/26/2008
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Last Update Date | 03/20/2009
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Provider Practice Location Address
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Address Line | 895 PORTLAND RD
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City | SACO
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State | ME
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Zip | 04072-9673
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Country | US
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Telephone | 207-571-9329
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Fax | 207-571-9328
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Provider Business Mailing Address
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Address Line | 895 PORTLAND RD
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City | SACO
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State | ME
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Zip | 04072-9673
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Country | US
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Telephone | 207-571-9329
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Fax | 207-571-9328
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Authorized Official
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Title or Position | OWNER
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Name | TAMERA AHEARN
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Credential |
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Telephone | 207-571-9329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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