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General NPI Number Information
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NPI Number | 1912374083
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Entity Type | Organization
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Legal Business Name | EMBASSY LONGMEADOW LLC
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 565 BRYN MAWR ST
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City | RAVENNA
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State | OH
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Zip | 44266-9696
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Country | US
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Telephone | 330-297-5781
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Fax | 330-297-6921
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Provider Business Mailing Address
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Address Line | 24579 BROADWAY AVE
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City | OAKWOOD VILLAGE
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State | OH
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Zip | 44146-6338
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Country | US
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Telephone | 330-297-5781
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Fax | 330-297-6921
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Authorized Official
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Title or Position | ATTORNEY
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Name | HAYLEY B WILLIAMS
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Credential |
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Telephone | 216-706-3936
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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 | 1628N
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License Number State | OH
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