Healthcare Provider Details

I. General information

NPI: 1043787880
Provider Name (Legal Business Name): UNITY FOR DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 MORRIS AVE STE L-2
UNION NJ
07083-5918
US

IV. Provider business mailing address

3847 SCHENLEY AVE
GASTONIA NC
28056-6336
US

V. Phone/Fax

Practice location:
  • Phone: 973-856-4404
  • Fax: 973-228-3964
Mailing address:
  • Phone: 973-856-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: STEPHON TYNES
Title or Position: OWNER
Credential:
Phone: 973-856-4404