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General NPI Number Information
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NPI Number | 1730326224
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Entity Type | Organization
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Legal Business Name | CHARMED HOME HEALTH CARE SERVICES LLC
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 6201 E LAKE MEAD BLVD UNIT 104
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City | LAS VEGAS
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State | NV
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Zip | 89156-6990
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Country | US
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Telephone | 702-438-5335
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Fax | 702-438-5335
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Provider Business Mailing Address
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Address Line | 6201 E LAKE MEAD BLVD UNIT 104
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City | LAS VEGAS
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State | NV
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Zip | 89156-6990
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Country | US
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Telephone | 702-438-5335
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Fax | 702-438-5335
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Authorized Official
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Title or Position | OWNER/CARE GIVER
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Name | MRS. JENNIFER JO MATTIO KATSORIS
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Credential |
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Telephone | 702-426-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1007715014
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License Number State | NV
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