Healthcare Provider Details

I. General information

NPI: 1467020743
Provider Name (Legal Business Name): UNICA HC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2278 NICE AVE
MENTONE CA
92359-9655
US

IV. Provider business mailing address

3281 E GUASTI RD STE 700
ONTARIO CA
91761-7643
US

V. Phone/Fax

Practice location:
  • Phone: 909-794-1189
  • Fax:
Mailing address:
  • Phone: 949-981-8915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ROBERT POWELL
Title or Position: OWNER/PRESIDENT
Credential: NHA
Phone: 949-981-8915