1164939062 NPI number — UNITY HEALTHCARE LLC

Table of content: (NPI 1164939062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164939062 NPI number — UNITY HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITY HEALTHCARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MIRACLES REHABILITATION REMINGTON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164939062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47903-4699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-446-5417
Provider Business Mailing Address Fax Number:
765-446-5317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 W DIVISION STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REMINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-807-2773
Provider Business Practice Location Address Fax Number:
765-807-2774
Provider Enumeration Date:
01/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DIR OF BILLING
Authorized Official Telephone Number:
765-446-5417

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300082826 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201152530 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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