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General NPI Number Information
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NPI Number | 1932239167
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Entity Type | Organization
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Legal Business Name | FIVESTAR HEALTHCARE
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 697 DAVIS RD SUITE C
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-3062
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Country | US
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Telephone | 770-507-0202
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Fax |
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Provider Business Mailing Address
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Address Line | 697 DAVIS ROAD SUITE 300
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City | STOCKBRIDGE
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State | GA
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Zip | 30281
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Country | US
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Telephone | 770-507-0202
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOSHUA ANJORIN BELLO
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Credential | PH.D.
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Telephone | 770-507-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 031-R-0038
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License Number State | GA
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