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General NPI Number Information
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NPI Number | 1821878968
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Entity Type | Organization
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Legal Business Name | ALPHA-OMEGA HOMECARE AND SERVICES, LLC
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 6028 CHESTER AVE STE 207
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2285
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Country | US
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Telephone | 904-862-7390
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Fax |
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Provider Business Mailing Address
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Address Line | 10149 DOGWOOD CREEK DR
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City | JACKSONVILLE
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State | FL
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Zip | 32222-4122
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Country | US
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Telephone | 904-312-0318
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIA HART
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Credential |
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Telephone | 904-312-0318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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