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General NPI Number Information
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NPI Number | 1700021441
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Entity Type | Organization
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Legal Business Name | GENESIS
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 700 WALNUT RIDGE DR 3055
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City | IRVING
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State | TX
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Zip | 75038-1000
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Country | US
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Telephone | 469-835-6428
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Fax | 972-871-2740
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Provider Business Mailing Address
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Address Line | 700 WALNUT RIDGE DR 3055
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City | IRVING
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State | TX
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Zip | 75038-1000
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Country | US
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Telephone | 469-835-6428
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Fax | 972-871-2740
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Authorized Official
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Title or Position | PROVIDER
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Name | CARLA JOANNE HANNAH
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Credential |
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Telephone | 469-835-6428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 835552
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License Number State | TX
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