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General NPI Number Information
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NPI Number | 1720469893
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Entity Type | Organization
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Legal Business Name | SUPRENE HOME CARE GIVERS AGENCY 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 | 3011 W GRAND BLVD 858
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City | DETROIT
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State | MI
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Zip | 48202-3096
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Country | US
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Telephone | 313-782-4814
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Fax | 313-338-8985
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Provider Business Mailing Address
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Address Line | 32385 GLEN CV 5
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-3663
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Country | US
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Telephone | 313-782-4814
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Fax | 313-338-8985
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Authorized Official
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Title or Position | OWNER
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Name | MS. PAMALA JOY REED
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Credential |
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Telephone | 313-989-3576
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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 | E29729
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License Number State | MI
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