Healthcare Provider Details

I. General information

NPI: 1467169698
Provider Name (Legal Business Name): UNIQUE LIFE SKILLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 06/06/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 N ROSEMONT BLVD
TUCSON AZ
85712-2113
US

IV. Provider business mailing address

13210 N 72ND PL
SCOTTSDALE AZ
85260-3900
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-5534
  • Fax: 520-323-5017
Mailing address:
  • Phone: 845-825-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JACOB GRUNHUT
Title or Position: OWNER
Credential:
Phone: 845-825-3606