1316121213 NPI number — UNIQUE LIFE, INC.

Table of content: MISS SHELBY RAE WELCH SLPA (NPI 1992213706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316121213 NPI number — UNIQUE LIFE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIQUE LIFE, 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:
1316121213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1994 HUGES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-449-7891
Provider Business Mailing Address Fax Number:
347-449-7888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1994 HUGHES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-449-7891
Provider Business Practice Location Address Fax Number:
347-449-7888
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ACHAMPONG
Authorized Official First Name:
AKWASI
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
347-449-7891

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251C00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02518972 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02915906 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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