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General NPI Number Information
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NPI Number | 1790842284
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Entity Type | Organization
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Legal Business Name | EVERCARE
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 6085 MARSHALEE DR SUITE 110
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City | ELKRIDGE
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State | MD
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Zip | 21075-6023
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Country | US
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Telephone | 443-691-2440
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Fax |
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Provider Business Mailing Address
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Address Line | 34 CODY AVE
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City | BALTIMORE
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State | MD
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Zip | 21234-1376
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Country | US
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Telephone | 410-529-2960
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Fax |
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Authorized Official
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Title or Position | DIRECTIOR OF CLINICAL SERVICES
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Name | MRS. KRISTY DUFFEY
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Credential | CRNP
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Telephone | 443-506-4361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | R127624
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License Number State | MD
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