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General NPI Number Information
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NPI Number | 1811219942
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Entity Type | Organization
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Legal Business Name | PROVIDENCE GROUP HOME
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 1047 HILLBURN DR
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City | DALLAS
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State | TX
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Zip | 75217-4328
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Country | US
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Telephone | 214-680-9144
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Fax | 972-226-7935
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Provider Business Mailing Address
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Address Line | 3327 CHAPELWOOD DR
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City | SUNNYVALE
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State | TX
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Zip | 75182-4005
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Country | US
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Telephone | 214-680-9144
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Fax | 972-226-7935
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Authorized Official
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Title or Position | OWNER
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Name | MR. POLYCARP ANAYO OHAKWE
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Credential |
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Telephone | 214-680-9144
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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 |
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