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General NPI Number Information
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NPI Number | 1730473109
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Entity Type | Organization
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Legal Business Name | MERCED HOME, INC
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 11451 TRUE WAY
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City | GARDEN GROVE
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State | CA
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Zip | 92840-2330
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Country | US
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Telephone | 714-583-8572
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Fax | 714-761-1747
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Provider Business Mailing Address
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Address Line | 12446 SUMMERWIND ST
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City | CERRITOS
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State | CA
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Zip | 90703-8328
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Country | US
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Telephone | 562-716-5958
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Fax | 562-402-1411
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. REYNALDA MERCED
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Credential |
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Telephone | 562-714-7363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 060000434
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License Number State | CA
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