Healthcare Provider Details

I. General information

NPI: 1134578792
Provider Name (Legal Business Name): UNI-HOPE LIFE SKILLS AND SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 SE 14TH ST APT 4206
DES MOINES IA
50320-1621
US

IV. Provider business mailing address

5515 SE 14TH ST APT 4206
DES MOINES IA
50320-1621
US

V. Phone/Fax

Practice location:
  • Phone: 515-822-9864
  • Fax:
Mailing address:
  • Phone: 515-822-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIA

VIII. Authorized Official

Name: MR. BERNARD JOSEPH MUSHI
Title or Position: MEMBER
Credential:
Phone: 515-822-9864