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General NPI Number Information
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NPI Number | 1801892070
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Entity Type | Organization
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Legal Business Name | CHC - CHESTNUT RIDGE NURSING & REHAB CTR, LLC
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 125 SAMARITAN DR
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City | CUMMING
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State | GA
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Zip | 30040-2354
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Country | US
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Telephone | 770-889-0120
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Fax | 770-887-5626
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Provider Business Mailing Address
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Address Line | 125 SAMARITAN DR
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City | CUMMING
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State | GA
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Zip | 30040-2354
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Country | US
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Telephone | 770-889-0120
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Fax | 770-887-5626
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | MR. MITCHELL STARER
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Credential |
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Telephone | 914-390-4300
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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 | 10581759
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License Number State | GA
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