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General NPI Number Information
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NPI Number | 1770806291
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Entity Type | Organization
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Legal Business Name | BROC LLC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 300 BLUE RIDGE ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-7261
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Country | US
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Telephone | 276-638-8701
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Fax | 276-638-8843
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Provider Business Mailing Address
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Address Line | 1400 CENTREPARK BLVD STE 810
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-7412
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Country | US
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Telephone | 239-963-3400
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Fax | 239-963-3410
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Authorized Official
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Title or Position | DIRECTOR OF M.I.S.
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Name | MRS. DORENE M FORD
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Credential |
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Telephone | 239-963-3400
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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 |
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License Number State |
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