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General NPI Number Information
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NPI Number | 1689856692
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Entity Type | Organization
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Legal Business Name | MARYS CARE CENTER
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 30796 SW 189 AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030
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Country | US
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Telephone | 305-498-9171
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Fax | 305-245-5095
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Provider Business Mailing Address
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Address Line | 30796 SW 189 AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030
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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 | OWNER
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Name | MARITZA BRITO
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Credential |
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Telephone | 305-498-9171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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