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General NPI Number Information
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NPI Number | 1164384087
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Entity Type | Organization
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Legal Business Name | UNLIMITED SUPPORTS & CONSULTING AGENCY LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 5103 MALLISON WAY
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-9004
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Country | US
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Telephone | 336-303-6922
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Fax | 336-303-6922
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Provider Business Mailing Address
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Address Line | 5103 MALLISON WAY
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-9004
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Country | US
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Telephone | 336-303-6922
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Fax | 336-303-6922
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Authorized Official
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Title or Position | OWNER
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Name | LATOYA CELESTE TATE
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Credential |
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Telephone | 336-303-6922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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