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General NPI Number Information
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NPI Number | 1710368808
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Entity Type | Organization
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Legal Business Name | HARBOR HOME HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 2890 EMMA LEE ST SUITE 210
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City | FALLS CHURCH
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State | VA
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Zip | 22042-7805
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Country | US
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Telephone | 703-734-6683
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Fax | 703-879-7594
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Provider Business Mailing Address
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Address Line | 2890 EMMA LEE ST SUITE 210
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City | FALLS CHURCH
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State | VA
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Zip | 22042-7805
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Country | US
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Telephone | 703-734-6683
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Fax | 703-879-7594
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | MR. ABDINASIR MOHAMUD
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Credential | CPA
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Telephone | 703-599-4395
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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 | HCO151293
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License Number State | VA
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