1912384017 NPI number — UNIQUE'S PROFESSIONAL SERVICES, LLC

Table of content: (NPI 1912384017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912384017 NPI number — UNIQUE'S PROFESSIONAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIQUE'S PROFESSIONAL SERVICES, 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:
1912384017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 TULLIS DR
Provider Second Line Business Mailing Address:
APT 2-103
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70131-8907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-864-7834
Provider Business Mailing Address Fax Number:
844-864-7834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1799 STUMPF BLVD
Provider Second Line Business Practice Location Address:
BUILDING 7, SUITE 9A
Provider Business Practice Location Address City Name:
TERRYTOWN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-3950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-864-7834
Provider Business Practice Location Address Fax Number:
844-864-7834
Provider Enumeration Date:
04/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DIXON
Authorized Official First Name:
VONNCEDRIC
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWENER/MANAGER
Authorized Official Telephone Number:
844-864-7834

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  14432993 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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