Healthcare Provider Details

I. General information

NPI: 1134834633
Provider Name (Legal Business Name): UNITED COMMUNITIES ASSISTANCE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 CEDAR GROVE RD SW
SUPPLY NC
28462-3017
US

IV. Provider business mailing address

1269 CEDAR GROVE RD SW
SUPPLY NC
28462-3017
US

V. Phone/Fax

Practice location:
  • Phone: 910-253-0600
  • Fax:
Mailing address:
  • Phone: 910-253-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA BROOKS
Title or Position: CEO
Credential:
Phone: 910-253-0600