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General NPI Number Information
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NPI Number | 1912950932
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Entity Type | Organization
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Legal Business Name | JOHNRE CARE LLC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 461 E JOHNSTON AVE
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City | HEMET
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State | CA
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Zip | 92543-7113
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Country | US
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Telephone | 951-658-6374
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Fax | 951-658-5263
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Provider Business Mailing Address
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Address Line | 16162 PONDEROSA LN
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City | RIVERSIDE
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State | CA
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Zip | 92504-6155
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Country | US
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Telephone | 951-780-5348
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Fax | 951-780-5348
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHNNY SICAT
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Credential |
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Telephone | 951-313-5685
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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 |
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