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General NPI Number Information
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NPI Number | 1992930614
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Entity Type | Organization
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Legal Business Name | SH CCRC, LLC
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 5170 S VANDALIA AVE
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City | TULSA
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State | OK
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Zip | 74135
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Country | US
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Telephone | 918-496-3963
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Fax | 918-496-0774
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Provider Business Mailing Address
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Address Line | 1400 CENTREPARK BLVD STE 810
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-7412
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Country | US
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Telephone | 239-963-3400
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Fax | 239-963-3401
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Authorized Official
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Title or Position | DIRECTOR OF MIS
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Name | MS. DORENE M FORD
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Credential |
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Telephone | 239-963-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH7227-7227
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License Number State | OK
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