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General NPI Number Information
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NPI Number | 1962759738
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Entity Type | Organization
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Legal Business Name | CECROPIA S BALLARD LLC
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Dates
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Enumeration Date | 08/10/2012
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 1891 MYRICK RD
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City | TALLAHASSEE
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State | FL
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Zip | 32303-4335
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Country | US
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Telephone | 850-766-8286
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Fax |
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Provider Business Mailing Address
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Address Line | 1891 MYRICK RD
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City | TALLAHASSEE
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State | FL
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Zip | 32303-4335
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Country | US
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Telephone | 850-766-8286
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CECROPIA BALLARD
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Credential | LCWS
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Telephone | 850-577-0208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | SW7996
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | SW7996
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | SW7996
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License Number State | FL
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