MEDICARE: U1ST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1093677130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U1ST

Provider Business Mailing Address
First Line	:	3118 WILLIAMSBURG ST NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-2255
Country	:	US
Telephone Number	:	330-853-8627
Fax Number	:

Provider Business Practice Location Address
First Line	:	3118 WILLIAMSBURG ST NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44485-2255
Country	:	US
Telephone Number	:	330-853-8627
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EBONIE BOURGOIN
Credential	:
Telephone Number	:	330-853-8627

Provider Enumeration Date	:	11/26/2025
Last Update Date	:	11/26/2025

Similar Medicare Providers

1962366104 — U1ST FOUNDATION
Practice Location Address:

3118 WILLIAMSBURG ST NW
WARREN, OH
44485-2255

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1396692364 — JUSTIN JUROVCIK
Practice Location Address:

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1245186600 — KELLY ANN GRAHAM
Practice Location Address:

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1942292461 — DR. SHARON L GEORGE D.O.
Practice Location Address:

420 SOUTHERN BLVD NW
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Directions to “U1ST ” Practice Location

Language	Start Address	Practice Location

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