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General NPI Number Information
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NPI Number | 1891986964
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Entity Type | Organization
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Legal Business Name | GL HEALTHCARE
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 470 GARFIELD AVE
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City | EVANSVILLE
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State | WI
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Zip | 53536-1014
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Country | US
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Telephone | 608-882-6557
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Fax | 608-882-6559
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Provider Business Mailing Address
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Address Line | 2620 WAUNONA WAY
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City | MADISON
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State | WI
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Zip | 53713-1525
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Country | US
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Telephone | 608-223-1452
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ILENE LARSON
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Credential | PT
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Telephone | 608-223-1452
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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 | 963-019
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License Number State | WI
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