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General NPI Number Information
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NPI Number | 1871503417
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Entity Type | Organization
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Legal Business Name | PINECREST CONVALESCENT CENTER, LLC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 13650 NE 3RD CT
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City | NORTH MIAMI
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State | FL
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Zip | 33161-3626
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Country | US
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Telephone | 305-893-1170
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Fax | 305-899-2817
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Provider Business Mailing Address
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Address Line | 13650 NE 3RD CT
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City | NORTH MIAMI
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State | FL
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Zip | 33161-3626
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Country | US
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Telephone | 305-893-1170
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Fax | 305-899-2817
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAVID GOLD
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Credential | LCSW, MBA
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Telephone | 305-893-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 13413
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 14400961
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License Number State | FL
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