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General NPI Number Information
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NPI Number | 1770620734
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Entity Type | Organization
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Legal Business Name | MY HOME INC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1639 MANZANITA AVENUE
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City | SANTA ROSA
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State | CA
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Zip | 95404
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Country | US
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Telephone | 707-539-7435
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Fax | 707-539-7435
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Provider Business Mailing Address
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Address Line | 1983 MT OLIVE DR
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City | SANTA ROSA
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State | CA
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Zip | 95404
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Country | US
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Telephone | 707-527-5744
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Fax | 707-527-5744
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | MS. HORTENSIA MARIE SANDOVAL
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Credential |
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Telephone | 707-527-5744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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