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General NPI Number Information
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NPI Number | 1801288527
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Entity Type | Organization
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Legal Business Name | COPROVIDERS
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 5987 112TH PL
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City | LIVE OAK
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State | FL
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Zip | 32060-7270
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Country | US
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Telephone | 386-697-1156
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Fax | 352-271-4255
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Provider Business Mailing Address
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Address Line | 5987 112TH PL
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City | LIVE OAK
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State | FL
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Zip | 32060-7270
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Country | US
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Telephone | 386-697-1156
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Fax | 352-271-4255
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Authorized Official
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Title or Position | OWNER
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Name | CHERYL A. OSGOOD
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Credential |
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Telephone | 386-697-1156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | FL
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