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General NPI Number Information
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NPI Number | 1912071630
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Entity Type | Organization
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Legal Business Name | PHS/CAMBRIDGE CARE CENTER, LLC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 548 1ST AVE W
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1020
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Country | US
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Telephone | 763-689-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 548 1ST AVE W
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1020
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Country | US
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Telephone | 763-231-0410
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Fax | 763-231-0420
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Authorized Official
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Title or Position | CFO
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Name | MR. MARK MEYER
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Credential |
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Telephone | 651-631-6120
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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 |
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License Number State | MN
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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 | 342879
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License Number State | MN
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