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General NPI Number Information
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NPI Number | 1700143427
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Entity Type | Organization
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Legal Business Name | NURSING FACILITY
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 85 LINHOME DR APT 8
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City | WEST HENRIETTA
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State | NY
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Zip | 14586-9963
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Country | US
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Telephone | 585-287-4014
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Fax |
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Provider Business Mailing Address
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Address Line | 85 LINHOME DRIVE #8
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City | WEST HENRIETTA
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State | NY
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Zip | 14586
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Country | US
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Telephone | 585-287-4014
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | SAVONNE SHARON ALEXANDRE
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Credential |
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Telephone | 585-287-4014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 308528
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License Number State | NY
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