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General NPI Number Information
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NPI Number | 1992920961
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Entity Type | Organization
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Legal Business Name | EXTENDED AFTERCARE, INC.
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5002 N SHEPHERD DR
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City | HOUSTON
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State | TX
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Zip | 77018-1625
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Country | US
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Telephone | 713-695-8403
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Fax | 713-695-3439
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Provider Business Mailing Address
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Address Line | 5002 N SHEPHERD DR
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City | HOUSTON
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State | TX
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Zip | 77018-1625
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Country | US
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Telephone | 713-695-8403
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Fax | 713-695-3439
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. STEVEN MICHAEL BOON
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Credential |
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Telephone | 713-695-8403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 593
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License Number State | TX
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