Healthcare Provider Details

I. General information

NPI: 1295416048
Provider Name (Legal Business Name): UNITED SERVICE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 S SARIVAL AVE
GOODYEAR AZ
85338-3505
US

IV. Provider business mailing address

3226 S SARIVAL AVE
GOODYEAR AZ
85338-3505
US

V. Phone/Fax

Practice location:
  • Phone: 623-696-8960
  • Fax:
Mailing address:
  • Phone: 623-696-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY KARINA PINEDO
Title or Position: CEO/OWNER
Credential:
Phone: 623-696-8960