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General NPI Number Information
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NPI Number | 1811560311
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Entity Type | Organization
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Legal Business Name | SAN AGUSTIN HOSPICE, LLC
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 1220 SAN AGUSTIN AVE
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City | LAREDO
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State | TX
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Zip | 78040-6307
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Country | US
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Telephone | 956-704-5096
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Fax | 956-441-1751
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Provider Business Mailing Address
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Address Line | 1220 SAN AGUSTIN AVE
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City | LAREDO
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State | TX
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Zip | 78040-6307
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Country | US
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Telephone | 956-704-5096
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Fax | 956-441-1732
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Authorized Official
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Title or Position | MEMBER
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Name | MR. EDUARDO DAVILA JR.
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Credential |
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Telephone | 956-516-2732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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