1255343661 NPI number — UNITY BEHAVIORAL HEALTH, LLC

Table of content: (NPI 1255343661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255343661 NPI number — UNITY BEHAVIORAL HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITY BEHAVIORAL HEALTH, 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:
Provider Other Organization Name Type Code:
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:
1255343661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 BEAVER DAM REACH
Provider Second Line Business Mailing Address:
THE WOODS AT SEASIDE
Provider Business Mailing Address City Name:
REHOBOTH BEACH
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19971-6102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-227-7399
Provider Business Mailing Address Fax Number:
302-227-7398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
153 BEAVER DAM REACH
Provider Second Line Business Practice Location Address:
THE WOODS AT SEASIDE
Provider Business Practice Location Address City Name:
REHOBOTH BEACH
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19971-6102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-227-7399
Provider Business Practice Location Address Fax Number:
302-227-7398
Provider Enumeration Date:
08/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHUBERT
Authorized Official First Name:
DUANE
Authorized Official Middle Name:
DOYLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-227-7399

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  C1-0005815 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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