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General NPI Number Information
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NPI Number | 1700864204
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Entity Type | Organization
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Legal Business Name | MORA VALLEY COMMUNITY HEALTH SERVICES, INC
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | STATE HIGHWAY 518 MILEMARKER 26
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City | MORA
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State | NM
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Zip | 87732-0209
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Country | US
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Telephone | 575-387-6078
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Fax | 575-387-2034
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Provider Business Mailing Address
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Address Line | PO BOX 209 STATE HWY 518 MM 26
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City | MORA
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State | NM
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Zip | 87732-0209
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Country | US
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Telephone | 575-387-5069
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Fax | 575-387-9011
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Authorized Official
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Title or Position | OFFICE MANAGER CARDID DE SAN ANTONI
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Name | MRS. LORRAINE FRENCH
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Credential |
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Telephone | 575-387-6078
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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 | 6008
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License Number State | NM
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