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General NPI Number Information
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NPI Number | 1699815530
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Entity Type | Organization
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Legal Business Name | ST JACOB HOSPICE INC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 17042 DEVONSHIRE ST SUITE 209
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City | NORTHRIDGE
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State | CA
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Zip | 91325-1674
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Country | US
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Telephone | 818-368-9995
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Fax |
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Provider Business Mailing Address
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Address Line | 17042 DEVONSHIRE ST #209
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City | NORTHRIDGE
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State | CA
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Zip | 91325
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANAHIT KHRIMIAN
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Credential | OWNER
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Telephone | 818-368-9995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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