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General NPI Number Information
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NPI Number | 1942884879
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Entity Type | Organization
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Legal Business Name | UNITICARE
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 10116 MARVEL COVE ST
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City | LAS VEGAS
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State | NV
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Zip | 89141-8771
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Country | US
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Telephone | 702-912-8981
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Fax |
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Provider Business Mailing Address
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Address Line | 10116 MARVEL COVE ST
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City | LAS VEGAS
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State | NV
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Zip | 89141-8771
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Country | US
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Telephone | 702-912-8981
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DOMNNIQUE RICE-MILLER
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Credential |
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Telephone | 570-369-6642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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