Healthcare Provider Details

I. General information

NPI: 1487345518
Provider Name (Legal Business Name): UNICARE COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5549 VAN BUREN BLVD
RIVERSIDE CA
92503-2068
US

IV. Provider business mailing address

437 N EUCLID AVE
ONTARIO CA
91762-3456
US

V. Phone/Fax

Practice location:
  • Phone: 951-324-5901
  • Fax:
Mailing address:
  • Phone: 909-749-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KELLY HONG VO
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 909-749-1835