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General NPI Number Information
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NPI Number | 1841677523
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Entity Type | Organization
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Legal Business Name | NEW SMYRNA BEACH ASSISTED LIVING FACILITY, INC.
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 5 FAIRGREEN AVE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-6112
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Country | US
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Telephone | 386-410-3201
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Fax |
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Provider Business Mailing Address
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Address Line | 260 SPRING FOREST DR
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-8700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMELA S OWENS
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Credential |
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Telephone | 386-527-3781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12638
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License Number State | FL
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