1942784285 NPI number — OUR HOME OF UNITY LLC

Table of content: (NPI 1942784285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942784285 NPI number — OUR HOME OF UNITY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUR HOME OF UNITY 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:
1942784285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7141 W CARTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAVEEN
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85339-7059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-891-0610
Provider Business Mailing Address Fax Number:
480-525-7974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7019 S 77TH LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAVEEN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85339-7231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-761-2860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HOPSON
Authorized Official First Name:
TLAHJONTE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINSTRATOR
Authorized Official Telephone Number:
602-799-2757

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: BH5550 . This is a "STATE OF ARIZONA DEPARTMENT OF HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: BH5904 . This is a "AZ DEPT OF HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: BH5738 . This is a "STATE OF ARIZONA DEPARTMENT OF HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: BH5953 . This is a "AZ DEPT OF HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: BH5954 . This is a "AZ DEPT OF HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 444686 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: BH5731 . This is a "STATE OF ARIZONA DEPARTMENT OF HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com