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General NPI Number Information
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NPI Number | 1699168468
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Entity Type | Organization
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Legal Business Name | LA POINCIANA ALF, LLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 200 POINCIANA AVE
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City | PORT ORANGE
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State | FL
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Zip | 32127-6318
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Country | US
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Telephone | 386-310-4558
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Fax | 386-304-2115
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Provider Business Mailing Address
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Address Line | 200 POINCIANA AVE
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City | PORT ORANGE
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State | FL
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Zip | 32127-6318
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Country | US
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Telephone | 386-310-4558
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Fax | 386-304-2115
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Authorized Official
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Title or Position | OWNER / ADMINISTRATOR
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Name | MRS. CARMELLE LAPORTE
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Credential | NURSE
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Telephone | 386-310-4558
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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 | FL
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