Healthcare Provider Details

I. General information

NPI: 1568107795
Provider Name (Legal Business Name): UNIFIED HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 03/05/2023
Certification Date: 03/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9014 S CENTRAL AVE
PHOENIX AZ
85042-8304
US

IV. Provider business mailing address

4250 N 19TH AVE
PHOENIX AZ
85015-5108
US

V. Phone/Fax

Practice location:
  • Phone: 602-384-8820
  • Fax:
Mailing address:
  • Phone: 602-384-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: FUNSO OGUNLA
Title or Position: OWNER
Credential:
Phone: 602-384-8820