Healthcare Provider Details

I. General information

NPI: 1336834332
Provider Name (Legal Business Name): UNITED AND GUIDED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 BROADWAY
SACRAMENTO CA
95817-3302
US

IV. Provider business mailing address

3810 BROADWAY
SACRAMENTO CA
95817-3302
US

V. Phone/Fax

Practice location:
  • Phone: 800-707-3358
  • Fax:
Mailing address:
  • Phone: 800-707-3358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MR. IMANI LUCAS
Title or Position: EXECUTIVE DIRECTOR
Credential: MS
Phone: 800-707-3358