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General NPI Number Information
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NPI Number | 1912204314
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Entity Type | Organization
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Legal Business Name | CORELIEF CENTER
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 643 DR MICHAEL DEBAKEY DR
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5726
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Country | US
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Telephone | 337-475-6334
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Fax | 337-475-6327
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Provider Business Mailing Address
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Address Line | 2301 E PRIEN LAKE RD SUITE B
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City | LAKE CHARLES
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State | LA
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Zip | 70601-7976
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Country | US
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Telephone | 337-475-6334
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NINA VARGAS
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Credential |
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Telephone | 337-475-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | MD11215R
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License Number State | LA
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