Healthcare Provider Details

I. General information

NPI: 1457037178
Provider Name (Legal Business Name): ASPIRED UNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

62 E MAIN ST
STATESBORO GA
30458-4844
US

IV. Provider business mailing address

62 E MAIN ST
STATESBORO GA
30458-4844
US

V. Phone/Fax

Practice location:
  • Phone: 912-542-0494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRANDON WILCHER
Title or Position: CEO
Credential:
Phone: 912-542-0494