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General NPI Number Information
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NPI Number | 1699225813
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Entity Type | Organization
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Legal Business Name | CLAIBORNE OPERATOR GROUP LLC
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 6942 HIGHWAY 79
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City | HOMER
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State | LA
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Zip | 71040-2023
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Country | US
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Telephone | 318-972-3586
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Fax | 318-927-4656
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Provider Business Mailing Address
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Address Line | 101 N 2ND ST 200
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City | WEST MONROE
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State | LA
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Zip | 71291-3266
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Country | US
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Telephone | 318-972-3586
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Fax | 318-927-4656
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DAWNE R SMITH
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Credential |
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Telephone | 318-812-2140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2203782944
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License Number State | LA
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