Healthcare Provider Details

I. General information

NPI: 1649806134
Provider Name (Legal Business Name): YOUNIVERSAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N MAIN ST
WARRENTON NC
27589-1922
US

IV. Provider business mailing address

126 N MAIN ST
WARRENTON NC
27589-1922
US

V. Phone/Fax

Practice location:
  • Phone: 252-879-0135
  • Fax: 252-879-0136
Mailing address:
  • Phone: 252-879-0135
  • Fax: 252-879-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LERIN GIANNI BURNETTE
Title or Position: CEO
Credential:
Phone: 252-762-9148