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General NPI Number Information
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NPI Number | 1992015135
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Entity Type | Organization
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Legal Business Name | CAROL I PEAKE LLC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 11/20/2010
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Provider Practice Location Address
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Address Line | 5830 WOODROW DR
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City | SYLVANIA
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State | OH
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Zip | 43560-1245
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Country | US
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Telephone | 419-488-2089
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Fax |
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Provider Business Mailing Address
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Address Line | 5830 WOODROW DR
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City | SYLVANIA
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State | OH
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Zip | 43560-1245
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Country | US
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Telephone | 419-488-2089
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | MRS. CAROL I. PEAKE
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Credential | NP-C
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Telephone | 41948810890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 1992015135
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 2127186
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number | 177151
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 281P00000X
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Taxonomy Name | Chronic Disease Hospital
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License Number | 1467635664
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 177151
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License Number State | OH
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