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General NPI Number Information
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NPI Number | 1699407981
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Entity Type | Organization
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Legal Business Name | IMMENSE PROVIDERS HOME CARE LLC
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 1 INTERNATIONAL PLZ STE 550
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City | PHILADELPHIA
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State | PA
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Zip | 19113-1528
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Country | US
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Telephone | 672-593-9572
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Fax |
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Provider Business Mailing Address
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Address Line | 1 INTERNATIONAL PLZ STE 550
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City | PHILADELPHIA
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State | PA
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Zip | 19113-1528
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Country | US
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Telephone | 215-617-3839
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAKEERAH JOHNSON
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Credential |
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Telephone | 267-259-3957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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