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General NPI Number Information
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NPI Number | 1699710186
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Entity Type | Organization
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Legal Business Name | MLB JEFFERSONVILLE HEALTH FACILITIES, INC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1720 E 8TH ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-4659
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Country | US
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Telephone | 813-635-9500
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Fax | 813-635-0081
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Provider Business Mailing Address
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Address Line | 3922 COCONUT PALM DR
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City | TAMPA
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State | FL
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Zip | 33619-1388
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Country | US
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Telephone | 813-635-9500
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Fax | 813-635-0081
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Authorized Official
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Title or Position | CFO
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Name | MR. WILLIAM MANDO
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Credential |
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Telephone | 813-635-9500
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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 |
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License Number State | IN
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