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General NPI Number Information
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NPI Number | 1831543818
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Entity Type | Organization
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Legal Business Name | CARE OPTIONS ONE
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Dates
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Enumeration Date | 04/16/2016
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Last Update Date | 04/16/2016
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Provider Practice Location Address
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Address Line | 439 ROBINSON DR
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City | TUSTIN
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State | CA
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Zip | 92782-0907
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Country | US
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Telephone | 818-629-8678
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Fax |
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Provider Business Mailing Address
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Address Line | 12632 CROSSDALE AVE
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City | NORWALK
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State | CA
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Zip | 90650-2671
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Country | US
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Telephone | 818-629-8678
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Fax |
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Authorized Official
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Title or Position | C.A.LICENSED PROGRAM ADMINISTRATOR
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Name | DANIEL I IMOESIRI
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Credential | B.A.,R.N.A.
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Telephone | 818-629-8678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 6031197740
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6031197740
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 6031197740
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | 6031197740
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License Number State | CA
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