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General NPI Number Information
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NPI Number | 1962301895
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Entity Type | Organization
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Legal Business Name | COOPER CITY 2580, LLC
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Dates
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Enumeration Date | 11/05/2026
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 2580 PINE ISLAND RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-8582
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Country | US
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Telephone | 754-253-0194
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Fax |
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Provider Business Mailing Address
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Address Line | 3011 TOWNSGATE RD STE 220
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City | WESTLAKE VLG
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State | CA
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Zip | 91361-5878
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Country | US
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Telephone | 805-981-8655
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Fax |
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Authorized Official
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Title or Position | PORTFOLIO SPECIALIST
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Name | ALISA LACY
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Credential |
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Telephone | 805-981-8655
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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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