Healthcare Provider Details

I. General information

NPI: 1710330550
Provider Name (Legal Business Name): DARLEEN UNIQUE PROVIDER SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2016
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 SW FREDRICA ST
PORT SAINT LUCIE FL
34983-1875
US

IV. Provider business mailing address

681 SW FREDRICA ST
PORT SAINT LUCIE FL
34983-1875
US

V. Phone/Fax

Practice location:
  • Phone: 954-655-9682
  • Fax:
Mailing address:
  • Phone: 954-655-9682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DARLENE DESSOURCES
Title or Position: PROVIDER
Credential:
Phone: 954-655-9682