1346553484 NPI number — UNITY GROUP HOMES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346553484 NPI number — UNITY GROUP HOMES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITY GROUP HOMES, 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:
UNITY ASSISTED LIVING HOME
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:
1346553484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 S VAL VISTA DR
Provider Second Line Business Mailing Address:
SUITE A3
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85296-1374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-202-2972
Provider Business Mailing Address Fax Number:
623-546-0161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
744 W 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85210-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-202-2972
Provider Business Practice Location Address Fax Number:
623-546-0161
Provider Enumeration Date:
07/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-202-2972

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL7524H , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3104A0630X , with the licence number: AL7524H , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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