1114014651 NPI number — UNITY & DIVERSITY HOME HEALTH CARE, INC.

Table of content: (NPI 1114014651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114014651 NPI number — UNITY & DIVERSITY HOME HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITY & DIVERSITY HOME HEALTH CARE, INC.
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:
1114014651
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:
6149 SANTA FE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28303-2579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-487-9061
Provider Business Mailing Address Fax Number:
910-488-4553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1804 MURCHISON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301-4025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-487-9061
Provider Business Practice Location Address Fax Number:
910-488-4553
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/ DIRECTOR
Authorized Official Telephone Number:
910-487-9061

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC2079 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6600793 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3409364 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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