Healthcare Provider Details

I. General information

NPI: 1770096810
Provider Name (Legal Business Name): UNLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2017
Last Update Date: 11/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 LONGWOOD DR APT N
REEDSPORT OR
97467-1162
US

IV. Provider business mailing address

2401 LONGWOOD DR APT N
REEDSPORT OR
97467-1162
US

V. Phone/Fax

Practice location:
  • Phone: 417-280-6941
  • Fax: 314-499-9047
Mailing address:
  • Phone: 417-280-6941
  • Fax: 314-499-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number201502205
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number201502205
License Number StateOR

VIII. Authorized Official

Name: VIRGINIA LEE UNDERWOOD
Title or Position: MANAGER
Credential: RN
Phone: 417-280-6941