Healthcare Provider Details

I. General information

NPI: 1699451641
Provider Name (Legal Business Name): UNITED PROTECTION SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 OLIVER ST
NORTH TONAWANDA NY
14120-2710
US

IV. Provider business mailing address

1020 OLIVER ST
NORTH TONAWANDA NY
14120-2710
US

V. Phone/Fax

Practice location:
  • Phone: 716-260-2040
  • Fax:
Mailing address:
  • Phone: 716-260-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JACAWAN JORDAN DANIEL
Title or Position: COUNSELOR
Credential: SOCIAL WORK (BSW)
Phone: 716-260-1620