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General NPI Number Information
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NPI Number | 1811168776
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Entity Type | Organization
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Legal Business Name | GOLD COAST COMPASSIONATE CARE,INC
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 901 PROGRESSO DR SUITE 204
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-1943
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Country | US
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Telephone | 954-462-1233
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Fax | 954-462-2981
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Provider Business Mailing Address
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Address Line | 901 PROGRESSO DR SUITE 204
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-1943
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Country | US
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Telephone | 954-462-1233
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Fax | 954-462-2981
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. WAYNE ALBERT BOYLAN
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Credential | R.N.
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Telephone | 954-462-1233
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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 | 30211267
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License Number State | FL
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