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General NPI Number Information
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NPI Number | 1699207324
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Entity Type | Organization
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Legal Business Name | FOREST GROVE HEALTHCARE, LLC
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 356 SE 9TH AVE
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City | HILLSBORO
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State | OR
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Zip | 97123-4202
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Country | US
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Telephone | 503-433-7757
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Fax | 503-433-7762
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Provider Business Mailing Address
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Address Line | 4363 SW ANDERSON RD
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City | FOREST GROVE
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State | OR
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Zip | 97116-8530
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Country | US
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Telephone | 503-433-7757
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Fax | 503-433-7762
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Authorized Official
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Title or Position | CEO & PROVIDER
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Name | MELINDA ANN SANFILIPPO
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Credential | FNP-C
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Telephone | 503-433-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 201708826NP
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License Number State | OR
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